Adult Resuscitation Adult Defibrillation Child Resuscitation Baby Resuscitation Special Resuscitation CPR Chart Abdominal Injuries Asthma Allergic Reaction

Download Bites and Stings Bleeding Burns and Scalds Chest Injuries Childbirth/Miscarriage Choking Cold Illness Convulsions/Seizures Croup Diabetes Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions Heat Illness Hyperventilation Mouth/Tooth Injuries e Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures Glossary INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 2

Adult Resuscitation About this eHandbook Adult Defibrillation This electronic version of the award winning First Aid Emergency Handbook, 5th edition (eHandbook) Child Resuscitation provides a quick summary of first aid for a range of every day emergencies whether at work, in sport Baby Resuscitation or recreation, or at home. The eHandbook does not attempt to replace the need for medical advice but gives an outline of what to do in the first few minutes after the onset of sudden illness or an accident. Special Resuscitation The first aid management recommended in this eHandbook is correct at June 2019 and in line with CPR Chart the 2016 Guidelines of the Australian Resuscitation Council, Poisons Information Centre and other professional bodies concerned with emergency care. Abdominal Injuries Because these recommendations change as a result of medical research and new knowledge, it is Asthma vital to update this eHandbook and your first aid training at regular intervals, approximately every Allergic Reaction three years. When there are new changes we will send you a email reminder. Keep a comprehensive first aid kit available for immediate use in an easily found location. If it is Bites and Stings for workplace use, check that it meets the relevant legislative requirements. Record all items used Bleeding and keep spare stock available to replenish the kit as needed. Burns and Scalds Chest Injuries How to use the eHandbook Childbirth/Miscarriage The tabs at the side and the Index provide a quick link to each topic. The Glossary gives a simple guide to the terms used in the eHandbook. Choking Resuscitation for an adult, child and baby is dealt with separately. Where roller bandages have been Cold Illness used to illustrate a technique, the bandages are marked with a dark edge as an aid to learning. Convulsions/Seizures The Skills and Procedures section covers the following topics: Croup • Principles of first aid • Assessment of a sick or injured person Diabetes • First aid and safety Drug/Alcohol Overdose • Emergency procedures Eye Injuries • Infection control in first aid Fractures/Dislocations • Dressing and bandages Head Injuries • Systems of the human body. Heart Conditions About the author Heat Illness Ella Tyler is a Registered Nurse and Midwife with two degrees in Adult Education. She has been involved with first aid teaching and instructor training for over 30 years and was a former Deputy Chairman of Hyperventilation the Australian Resuscitation Council. In 1985, Ella was awarded the International Florence Nightingale Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Medal. Currently Ella works in her own business as a first aid training consultant. She is author or editor of 18 first aid books. Poisoning Shock/Fainting About the publisher and copyright holder Spinal Injuries © 2019 Tyrrells IT Proprietary Limited, JW Tyrrell and TW Tyrrell. This electronic version of the First Aid Emergency Handbook, 5th edition, was first published in Australia in March 2014 by Tyrrells Sprains/Strains/Bruises Administration Pty Ltd, trading as Survival Emergency Solutions, PO Box 337, Gladesville NSW 1675. Stroke ISBN 978 192136673 4 Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 3

Adult Resuscitation Adult Defibrillation How to call for help in an Child Resuscitation Baby Resuscitation emergency Special Resuscitation

When possible, the person with the best first aid knowledge should stay with the CPR Chart victim while someone else calls for the emergency service. Abdominal Injuries 1 To call for the Ambulance, Police or Fire Service, use 000 for all fixed Asthma line telephones. Allergic Reaction • If you are using a digital mobile phone, call 000 or 112 unless your service Bites and Stings provider has advised otherwise. 112 is the international emergency number to be called when overseas. Bleeding Burns and Scalds 2 When the emergency operator answers, state clearly which service is required. Chest Injuries Childbirth/Miscarriage 3 Stay calm and speak clearly to convey the message. Be ready to answer any questions. Choking Cold Illness 4 State the following: Convulsions/Seizures • the exact location with any clear landmarks or identification points; Croup • an outline of the emergency; Diabetes

• the number of victims involved. Drug/Alcohol Overdose

• any information about the condition of the victim(s); Eye Injuries

• any hazards relevant to the area, such as fire, chemical spill, fumes; Fractures/Dislocations Head Injuries • the telephone number where the caller can be contacted in case further information is needed. Heart Conditions Heat Illness Wait on line until the operator tells you to hang up. 5 Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED 6 Ask someone to stay in a prominent position to direct the emergency service vehicle to the correct area. Poisoning Shock/Fainting Fire, Police or Ambulance 000 or mobile 112 Spinal Injuries Sprains/Strains/Bruises Poisons Information Centre 13 11 26 Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 4

Adult Resuscitation Adult Defibrillation Basic Life Support Flow Chart Child Resuscitation Baby Resuscitation Special Resuscitation Check for Dangers D CPR Chart Abdominal Injuries Asthma R Check Response Allergic Reaction Bites and Stings Bleeding S Send for help Burns and Scalds Chest Injuries Childbirth/Miscarriage A Clear and open the Airway Choking Cold Illness Convulsions/Seizures B Check for normal Breathing Croup Diabetes Drug/Alcohol Overdose Give 30 chest Compressions at 100 - 120 Eye Injuries C per minute, followed by 2 rescue breaths Fractures/Dislocations Head Injuries Defibrillate - attach AED as soon as Heart Conditions D available. Follow the prompts Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Continue CPR until qualified personnel arrive Poisoning or normal breathing returns. Shock/Fainting Monitor recovery until responsive. Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 5 1 of 5 Adult Resuscitation ADULT Adult Defibrillation Resuscitation Child Resuscitation Baby Resuscitation Background Special Resuscitation A person may collapse following injury or CPR Chart sudden illness and sometimes may need Cardiopulmonary Resuscitation (CPR). Abdominal Injuries Some victims may be unconscious and simply need protection to avoid further harm. Asthma Others will need urgent Cardiopulmonary Allergic Reaction Resuscitation (CPR) to maintain life. CPR is needed when there are no signs of Bites and Stings life and the victim is: Persons who may have taken an excessive amount of alcohol Bleeding • unconscious and not responding to the or drugs may be aggressive and first aider's voice and touch react unexpectedly. Avoid being Burns and Scalds • not breathing normally too close to the victim if you are unsure of your safety. Chest Injuries All collapsed victims should be carefully assessed to decide what emergency care is • If there is no response to your voice or Childbirth/Miscarriage needed. The DRSABCD of resuscitation is the touch, the victim is unconscious and needs method used for the assessment: you to protect the airway and ensure Choking that there is no immediate threat to life. D stands for DANGER Cold Illness R stands for RESPONSE Call 000 or mobile 112 for an ambulance. Convulsions/Seizures S stands for SEND (for help)  A stands for AIRWAY Croup B BREATHING Clear and open the irway stands for 3 A Diabetes C stands for COMPRESSIONS • Either leave the unconscious person in the D stands for DEFIBRILLATION position found to clear and open the airway Drug/Alcohol Overdose OR Eye Injuries • Turn the unconscious person into the What to do — step by step recovery position on the side. Fractures/Dislocations Assess any Danger If the victim has been rescued Head Injuries 1 from submersion or has vomit, • Only approach the collapsed person if blood or other fluid in the upper Heart Conditions you believe that it is safe to do so. Check airway, always use the recovery for any danger in the immediate area, position to clear the airway. Heat Illness especially traffic, electrical hazards, etc. Hyperventilation THE RECOVERY POSITION 2 Assess the victim’s Response Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED • If it is safe to continue, check for - Place the far arm at right angles to Poisoning response by giving a simple command, the trunk and the near arm across the victim’s chest with the fingers pointing then grasp and squeeze the shoulders Shock/Fainting firmly. Use simple commands such as to the opposite shoulder tip. Support the arm in that position. “Can you hear me?”, “Open your eyes.”, Spinal Injuries “What’s your name?”, “Squeeze my - Bring the near knee up at right angles hand; let it go”. If the victim responds, to the chest and support under the thigh Sprains/Strains/Bruises then gently and quietly assess the cause in that position with your lower arm. of the apparent collapse. Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 6 ADULT resuscitation 2 of 5 Adult Resuscitation • Then tilt back the head slightly with your upper hand on top of the victim’s Adult Defibrillation head. With your lower hand, support the jaw and lift the chin to ensure that Child Resuscitation the tongue is held forwards in the Baby Resuscitation mouth. Because the tongue is attached to the back of the lower jaw, this simple Special Resuscitation movement prevents the tongue from falling backwards to block the throat. CPR Chart • Make sure that the face is pointing slightly downwards. Abdominal Injuries Asthma Allergic Reaction Bites and Stings - Lift under the victim’s near shoulder and thigh to gently roll the victim away Bleeding from you and into a stable position on one side. Burns and Scalds - Keep the victim’s knee and hip at right Chest Injuries angles during the turn to keep the victim lying on the side, avoiding any Childbirth/Miscarriage excessive movement into a face-down position. Choking Check for breathing - Allow the victim’s upper arm to fall 4 Cold Illness across the lower arm in a natural • When the airway is clear and open: position. ~ Look for movement of the lower chest Convulsions/Seizures and upper abdomen. • Check that the victim’s airway is clear by ~ Listen for the escape of air from the Croup sweeping two or three fingers through victim’s mouth or nose. Diabetes the front of the mouth to remove any ~ Feel for movement of the lower chest solid matter. and abdomen and for the escape of air Drug/Alcohol Overdose from the victim’s mouth or nose. ~ Check for normal breathing but ignore Eye Injuries occasional gasps which are inadequate Fractures/Dislocations to maintain life. Head Injuries Heart Conditions Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning • If a broken tooth is found, remove it Shock/Fainting promptly to avoid the risk of inhalation into the airway. Spinal Injuries • Loose dentures should be removed for Sprains/Strains/Bruises safety, but well-fitting ones should be left in place. Stroke Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 7 ADULT resuscitation 3 of 5 Adult Resuscitation 5 If the victim is breathing normally • Place your lower hand above this point and your other hand on top of the Adult Defibrillation • Adjust the recovery position if necessary first and obtain a secure grip to avoid to ensure stability. Child Resuscitation accidental slipping out of position. A • Cover the victim with a blanket in cool secure grip is one in which the upper Baby Resuscitation weather or a light covering in hot weather. hand grasps the lower wrist with • Check the airway and signs of recovery the thumb locked behind the wrist. Special Resuscitation every few minutes and begin CPR if Alternatively, interlock the upper and normal breathing stops. lower fingers firmly together to hold CPR Chart them off the chest wall and avoid any downward pressure on the rib cage. Abdominal Injuries • Ensure that the heel of the hand Asthma is in the midline of the sternum (breastbone) and all pressure is exerted Allergic Reaction through the heel of the lower hand. Bites and Stings Bleeding Burns and Scalds Chest Injuries Childbirth/Miscarriage Choking Cold Illness 6 If the victim is NOT breathing Convulsions/Seizures normally Croup • If necessary, quickly roll the victim onto the back to begin CPR. Diabetes • First locate the centre of the chest Compress the sternum Drug/Alcohol Overdose checking that your hand is on the 7 victim’s sternum (breastbone) and not • Kneel close to the side of the victim, Eye Injuries below it and over the abdomen. with both arms locked straight at the elbows and your shoulders directly Fractures/Dislocations Avoid compressing too high or above the victim’s sternum. With your too low by quickly finding the hands on the chest exert downward Head Injuries notch where the ribs meet in pressure through the sternum without Heart Conditions the centre. any pressure on the rib cage. • Compress the sternum by pushing Heat Illness downwards on straight arms to depress the breastbone one-third of Hyperventilation the chest depth. When resistance is Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED felt, no further pressure should be

applied, but the arms should relax a Poisoning little as the compression ceases. Shock/Fainting • The first aider should maintain compressions at the rate of Spinal Injuries approximately 100 - 120 per minute until a total of 30 have been given. Sprains/Strains/Bruises • Follow the compressions immediately Stroke with two breaths of rescue breathing. Skills and Procedures

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© 201 © INDEX 4 FIRST AID EMERGENCY eHANDBOOK 5th ed 8 ADULT resuscitation 4 of 5 Adult Resuscitation Rescue Breathing 8 Adult Defibrillation • For mouth-to-mouth rescue breathing, tilt back the victim’s head with your Child Resuscitation upper hand and support the jaw with chin lift using the lower hand. Use a Baby Resuscitation ‘pistol grip’ to maintain control of the Special Resuscitation jaw. Avoid lifting or tilting the neck, especially when a neck injury is suspected. CPR Chart Abdominal Injuries Asthma Allergic Reaction Bites and Stings Bleeding Burns and Scalds • Take a deep breath in and seal the Chest Injuries victim’s mouth with your mouth. • When the chest is empty, repeat these Seal the victim’s nose with your cheek steps one more time to give a total of Childbirth/Miscarriage so that air does not escape. If unable two breaths of rescue breathing, allowing to seal the nose with your cheek, about one second for each breath. Choking pinch the nostrils closed. • Mouth to nose rescue breathing may Cold Illness If the nostrils are sealed with be used when the victim’s teeth are your fingers, some head tilt may tightly clenched or when giving rescue Convulsions/Seizures be lost when the hand on top of breathing to an infant or small child. the head comes forwards. Firmly Croup lifting the chin upwards with If you are unable to give your lower hand can reduce this rescue breaths, continue with Diabetes problem and avoid a see-sawing compressions alone. Drug/Alcohol Overdose movement of the head. Gloves are unnecessary as • Breathe into the victim’s mouth until the the cross-infection risks Eye Injuries chest rises, as for normal breathing. during CPR are negligible. Fractures/Dislocations Mouth to mask Rescue Breathing Head Injuries • Ideally position yourself at the head of the victim, looking towards the feet. Heart Conditions Use both hands to support the jaw with your fingers behind the angle of Heat Illness the jaw and maintain backward head tilt and chin lift. Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning Shock/Fainting • Remove your mouth from the victim’s face and turn your head towards the Spinal Injuries victim’s chest to listen and feel for air Sprains/Strains/Bruises leaving the mouth and nose, and to watch the chest empty. Be careful to Stroke avoid inhaling the victim’s exhaled air. Skills and Procedures

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© 201 © INDEX 5 FIRST AID EMERGENCY eHANDBOOK 5th ed 9 ADULT resuscitation 5 of 5 Adult Resuscitation • Place the mask on the victim’s face, with the he change-over should be done pointed end covering the bridge of the nose. with out interruption to the ratio Adult Defibrillation of breaths to compressions and in Child Resuscitation • Seal the rounded end on the victim’s chin the middle of a compression cycle. and ensure that both mouth and nose are totally enclosed in the mask to make a Baby Resuscitation total seal. Special Resuscitation • With the mask held firmly on the face, push down with your thumbs on either CPR Chart side of the mouthpiece. Pull the jaw up into the mask to ensure a good seal. Abdominal Injuries • Blow through the mouthpiece with sufficient Asthma volume until the chest is seen to rise. Allergic Reaction Bites and Stings Bleeding Burns and Scalds Chest Injuries Childbirth/Miscarriage If regurgitation occurs during CPR, quickly roll the victim onto Choking • Remove your mouth and turn your head the side to recheck and clear the to the side to listen as the exhaled air airway. Then continue CPR. Cold Illness escapes; watch the chest fall. 9 Check for recovery Convulsions/Seizures • Check constantly for any signs of Croup recovery including normal breathing, coughing or movement. Diabetes 10 If signs of recovery are seen Drug/Alcohol Overdose • Turn the victim on the side into the Eye Injuries recovery position and make further checks every few minutes until either Fractures/Dislocations the victim starts to regain consciousness • If the chest fails to rise with each breath, or an ambulance arrives. Head Injuries recheck head tilt, chin lift and mask seal on the face. Sometimes a slight change 11 Be ready to defibrillate when Heart Conditions of position may be effective. an AED becomes available • Apply an AED (Automated External Heat Illness Two person CPR Defibrillator) as soon as possible and Hyperventilation follow the prompts - See Defibrillation • If a second person arrives continue the ratio Mouth/Tooth Injuries of 30 compressions to two breaths, but the UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED When to stop resuscitation compressor must pause to allow the 12 Poisoning ventilations to occur. • Resuscitation should continue until: ~ the victim recovers The two first aiders may change Shock/Fainting over when either feels tired or ~ qualified help arrives and takes over stressed by their activity. This may ~ an authorised person pronounces that Spinal Injuries life is extinct be every two minutes or more Sprains/Strains/Bruises frequently, to avoid the ~ the first aider is unable to continue, compressor being exhausted. usually due to exhaustion. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 10 1 of 2 Adult Resuscitation ADULT Adult Defibrillation Defibrillation Child Resuscitation Baby Resuscitation What to do — step by step Background Special Resuscitation When a victim of a heart attack collapses, a The defibrillation unit should CPR Chart defibrillator may be needed to restore a only be attached to a victim over 8 years of age who has Abdominal Injuries normal heart rhythm. If the heart muscle collapsed and is unconscious, is quivering (ventricular fibrillation) use of with no response and no normal Asthma an Automated External Defibrillator (AED) breathing. may restore normal heart rhythm and Allergic Reaction thus be life-saving. 1 Prepare defibrillator Bites and Stings In cardiac arrest, when the heart is no • If possible, continue CPR while someone longer beating or quivering, a defibrillator Bleeding else fetches and prepares the defibrillator. is unlikely to be of value, but should be Burns and Scalds applied and left in place. An AED can assess any heart action and will only deliver Chest Injuries a defibrillation shock if this is warranted. Childbirth/Miscarriage If an AED is available and trained first aid personnel are present e.g., in a workplace Choking or large shopping centre, standard CPR Cold Illness should be commenced and continued until the AED is completely ready for use. An Convulsions/Seizures AED does not replace CPR but is an extra step in emergency care until the arrival of Croup an ambulance crew with additional life- Diabetes saving techniques. Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions 2 Expose the victim’s chest Heat Illness • Dry the skin if necessary to improve Hyperventilation adhesive contact with the pads. Mouth/Tooth Injuries • If the victim has a very hairy chest, UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

quickly trim the hair on the upper right Poisoning side of the chest. Shock/Fainting 3 Turn on the defibrillator and Spinal Injuries follow the voice prompts Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 11 Adult defibrillation 2 of 2 Adult Resuscitation 4 Position the pads 6 Delivery of the shock Adult Defibrillation • Identify the two pads which are usually • The trained first aider must quickly check Child Resuscitation supplied with a clear diagram for their that no person is in contact with the victim, location. The underside of the pad is usually call out “Shocking now”, before pressing Baby Resuscitation coated with a sticky gel to ensure adhesion the "Shock" button. to the chest. Remove any backing paper. Special Resuscitation • One pad is placed on the victims’ right upper CPR Chart chest, and the other is placed on the left lower chest. Both pads should be pressed Abdominal Injuries down firmly for a good contact. The voice prompt will advise “check electrodes” Asthma if the pads are not making good contact. Allergic Reaction Bites and Stings Bleeding Burns and Scalds Chest Injuries Childbirth/Miscarriage Choking Cold Illness

• When the defibrillation shock has been Convulsions/Seizures given the voice prompt will advise the first aider to continue with CPR. After Croup Prepare to defibrillate 5 two minutes when the unit is ready to Diabetes • When the unit is ready to analyse the victim’s analyse the victim’s heart rhythm again, heart rhythm, the voice prompt will advise the first aider will be told to stop CPR and, Drug/Alcohol Overdose everyone to avoid any contact with the victim. if necessary the defibrillator will advise a This is to avoid any interference with the further shock. Eye Injuries analysis. If the victim has a rhythm that is Fractures/Dislocations likely to respond to defibrillation, the voice 7 Follow-up care prompt will advise everyone to “Stand Head Injuries Clear” ready for the shock to be given. • This cycle of analysis, shocks and CPR will continue if the defibrillator senses that the Heart Conditions heart may respond to repeated shocks. Heat Illness • The unit should remain connected and the voice prompts followed until the Hyperventilation ambulance crew arrive even if the victim recovers and is turned into the recovery Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED position. Poisoning Shock/Fainting For a child aged one to eight years a child-safe AED should be used with Spinal Injuries special leads and pads. If this is not available, an adult AED may be used Sprains/Strains/Bruises in an emergency. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 12 1 of 5 Adult Resuscitation 3 Clear and open the Airway Adult Defibrillation CHILD • Either leave the unconscious child in Child Resuscitation the position found to clear and open Resuscitation the airway Baby Resuscitation OR Special Resuscitation • Turn the unconscious child into the Care is needed when giving recovery position on the side. CPR Chart resuscitation to a child aged between one and eight years. Abdominal Injuries If the victim has been rescued from submersion or has vomit, blood Asthma 1 Assess any Danger or other fluid in the upper airway, • Only approach the child if you believe always use the recovery position to Allergic Reaction that it is safe to do so. Check for any clear the airway. danger in the immediate area, especially Bites and Stings traffic, electrical hazards etc. THE RECOVERY POSITION Bleeding Assess the child’s Response - Place the far arm at right angles to the Burns and Scalds 2 trunk and the near arm across the child’s • If it is safe to continue, check if the child chest with the fingers pointing to the Chest Injuries responds to the spoken word. Ask loudly opposite shoulder tip. Support the arm and firmly: “Can you hear me?”, “Are in that position with your upper arm. Childbirth/Miscarriage you OK?” or “What happened?” Give a squeeze of the shoulders and watch - Bring the near knee up at right angles Choking for any reaction. If the child responds, to the chest and hold the thigh in that then gently and quietly assess the cause position with your lower arm. Cold Illness of collapse. Convulsions/Seizures Croup Diabetes Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions Heat Illness Hyperventilation - Lift under the child’s near shoulder and thigh to gently roll the victim away Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED from you and into a stable position on • If there is no response, or only a minor Poisoning one side. response to your voice or touch, the child is unconscious and needs your help - Keep the child’s knee and hip at right Shock/Fainting to protect the airway and ensure that angles during the turn to keep the Spinal Injuries there is no immediate threat to life. victim lying on the side, avoiding any excessive movement into a face-down Sprains/Strains/Bruises Call 000 or mobile 112 for an position.  ambulance. Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 13 CHILD resuscitation 2 of 5 Adult Resuscitation Adult Defibrillation - Allow the child’s upper arm to fall Child Resuscitation across the lower arm in a natural position. Baby Resuscitation Special Resuscitation CPR Chart Abdominal Injuries Asthma Allergic Reaction

• Make sure that the face is pointing Bites and Stings slightly downwards. Bleeding

In a child it is vital to maintain Burns and Scalds jaw support with chin lift because of the large amount Chest Injuries of soft tissue in the mouth and • Check that the child’s airway is clear by Childbirth/Miscarriage throat, which can cause an sweeping one or two fingers through airway obstruction. the front of the mouth to remove any Choking solid or loose matter. Cold Illness 4 Check for Breathing • When the airway is clear and open: Convulsions/Seizures ~ Look for movement of the lower Croup chest and upper abdomen. ~ Listen for the escape of air from the Diabetes child’s mouth or nose. Drug/Alcohol Overdose ~ Feel for movement of the lower chest and abdomen and for the escape of air Eye Injuries from the child’s mouth or nose. ~ Check for normal breathing but Fractures/Dislocations ignore occasional gasps which are Head Injuries • If a broken tooth is found, remove it inadequate to maintain life. promptly to avoid the risk of inhalation Heart Conditions into the airway. Heat Illness • Check that the child’s nose is clear and quickly wipe away any mucus or Hyperventilation other discharge that could obstruct the movement of air. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

• Tilt back the head very slightly with Poisoning your upper hand on top of the child’s head. With your lower hand support Shock/Fainting the jaw and lift the chin slightly. Because the tongue is attached to Spinal Injuries the back of the lower jaw, this simple movement prevents the tongue from Sprains/Strains/Bruises falling backwards to block the throat. Stroke Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 14 CHILD resuscitation 3 of 5 Adult Resuscitation 5 If the child is breathing • Place the heel of one hand over Adult Defibrillation normally the lower half of the sternum (breastbone). Keep the heel of the Child Resuscitation • Adjust the recovery position if hand in contact with the sternum and Baby Resuscitation necessary to ensure stability. fingers facing across the chest. • Cover the child with a blanket in Special Resuscitation cool weather or a light covering in hot weather. CPR Chart • Check the airway and signs of recovery, every few minutes and begin CPR if Abdominal Injuries normal breathing stops. Asthma Allergic Reaction Bites and Stings Bleeding Burns and Scalds Chest Injuries 7 Compress the sternum Childbirth/Miscarriage • Kneel close to the side of the child, Choking 6 If the child is NOT breathing with your arm locked straight at the normally elbow and your shoulder directly above Cold Illness the sternum. • If necessary quickly roll the child onto Convulsions/Seizures the back to begin CPR. • Keep your hand on the chest to exert • First locate the centre of the chest, downward pressure through the Croup checking that your hand is on the sternum without any pressure on the child’s sternum (breastbone) and not chest wall or rib cage. Diabetes below it and over the abdomen. Drug/Alcohol Overdose Avoid compressing too high or Eye Injuries too low by quickly finding the notch where the ribs meet in Fractures/Dislocations the centre. Head Injuries Heart Conditions Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 4 FIRST AID EMERGENCY eHANDBOOK 5th ed 15 CHILD resuscitation 4 of 5 Adult Resuscitation Adult Defibrillation • Compress the sternum by pushing • Take a small breath in and seal the downwards on a straight arm to child’s mouth with your mouth. Seal Child Resuscitation the child’s nose and blow gently into depress the breastbone one-third of the Baby Resuscitation depth of the chest. When resistance the child’s mouth until the chest rises, is felt, no further pressure should be as for normal breathing. Special Resuscitation applied, but the arm should relax as the compression ceases. CPR Chart • If necessary,use two hands to achieve Abdominal Injuries adequate compression. • The first aider should maintain Asthma compressions at the rate of Allergic Reaction approximately 100 - 120 per minute until a total of 30 have been given. Bites and Stings • Follow the compressions immediately with two breaths of rescue breathing Bleeding using either the mouth-to-mouth or Burns and Scalds mouth-to-nose resuscitation method. Then give a further 30 compressions. Chest Injuries Childbirth/Miscarriage Rescue Breathing 8 If the child is very small it is Choking • Begin rescue breathing using either best to seal both nose and the mouth-to-mouth or mouth-to-nose mouth with your mouth Cold Illness resuscitation method. during rescue breathing. Convulsions/Seizures • Tilt back the child’s head very slightly with your upper hand and support If there is resistance to each Croup the jaw with chin lift using your lower breath, gently try a little more hand. Use a “Pistol Grip” to maintain head tilt until an even flow of Diabetes control of the jaw. Avoid lifting or air is achieved. tilting the neck, especially where a Drug/Alcohol Overdose neck injury is suspected. • Remove your mouth from the child’s Eye Injuries face and turn your head sideways to Avoid full head tilt because this listen to the escape of air and watch Fractures/Dislocations can obstruct the airway of a young the chest empty. Be careful to avoid child and may cause unnecessary inhaling the child’s expired air. Head Injuries stress to the neck spine. Heart Conditions Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 5 FIRST AID EMERGENCY eHANDBOOK 5th ed 16 CHILD resuscitation 5 of 5 Adult Resuscitation • W hen the chest is empty, repeat these 10 If signs of recovery are seen Adult Defibrillation steps one more time to give a total of • Turn the child on the side into the Child Resuscitation two breaths of rescue breathing, allowing recovery position and make further about one second for each breath. Mouth- checks every two minutes until either Baby Resuscitation to-nose rescue breathing may be used the child starts to regain consciousness when the child’s teeth are tightly clenched. and responds to your voice or touch, Special Resuscitation It is easy to breathe too hard into a or an ambulance arrives. CPR Chart small child and some distension of the abdomen may be seen. If this Be ready to defibrillate when Abdominal Injuries occurs, simply turn the child into the 11 recovery position and clear and an AED becomes available Asthma open the airway again. If the • Apply an AED (Automated External stomach is distended with air, it will Defibrillator) as soon as possible and Allergic Reaction be expelled during the change of follow the prompts position. Then, quickly turn the child Bites and Stings onto the back once more and It is best to use a child-safe AED Bleeding continue resuscitation. with special settings, leads and pads. For a child the pads Burns and Scalds DO NOT apply pressure over the should be placed with one stomach or abdomen because this slightly to the centre left of the Chest Injuries can lead to regurgitation of stomach child's chest and the second contents with the risk that some pad in the centre of the back Childbirth/Miscarriage material may be inhaled into the between the shoulder blades. lungs, causing fatal complications. Choking When an ambulance arrives, Cold Illness Two person CPR the first aider should not stop resuscitation efforts until told Convulsions/Seizures • If there are two first aiders present and to do so by the ambulance officers. The officers may need sharing the resuscitation tasks, the ratio of Croup time to assemble their 30 compressions to two breaths should be equipment before being ready Diabetes maintained but the compressor must pause to take over full responsibility to allow the ventilations to occur. for performing resuscitation. Drug/Alcohol Overdose • When the first aider performing the Eye Injuries compressions is getting tired, the two first When to stop resuscitation aiders should change over roles. It is best to 12 Fractures/Dislocations do this in the middle of the 30 compressions • Resuscitation should continue until: Head Injuries to avoid any unnecessary interruptions to CPR. ~ the child recovers ~ qualified help arrives and takes over Heart Conditions Check for signs of recovery 9 care of the child Heat Illness • Check for signs of recovery including normal ~ an authorised person pronounces that breathing or coughing. life is extinct Hyperventilation ~ the first aider is unable to continue, Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED usually due to exhaustion. Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 17 1 of 5 Adult Resuscitation BABY Adult Defibrillation 3 Clear and open the Airway Child Resuscitation Resuscitation • Either leave the unconscious baby in the Baby Resuscitation position found to clear and open the airway Special Resuscitation Special care is needed when OR giving resuscitation to a baby CPR Chart aged up to one year. • Promptly turn the unconscious baby into the recovery position on the side. Abdominal Injuries Assess any Danger If the baby has been rescued from Asthma 1 submersion or has vomit, blood • Only approach the baby if you believe or other fluid in the upper airway, Allergic Reaction that it is safe to do so. Check for any always use the recovery position danger in the immediate area, especially to clear the airway. Bites and Stings traffic, electrical hazards etc. Bleeding 2 Assess the baby’s Response THE RECOVERY POSITION Burns and Scalds • If it is safe to continue, check if the - Roll the baby over onto one side using baby responds to your voice. Call the the hip and shoulder to control the turn. Chest Injuries baby loudly and firmly by name. Give a gentle squeeze of the baby’s toes. Childbirth/Miscarriage If the baby responds to your voice or Choking touch, then gently and quietly assess the cause of collapse. Cold Illness Convulsions/Seizures Croup Diabetes Drug/Alcohol Overdose - Keep the baby’s knee and hip under Eye Injuries control to maintain a stable position on the side. Avoid any further movement Fractures/Dislocations into a face-down position. Head Injuries - Check that the baby’s airway is clear by sweeping one finger through the front Heart Conditions of the mouth to remove any solid or loose matter. Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

• If there is no response or only a minor response to your voice or touch, the Poisoning baby is unconscious and needs your help to protect the airway and ensure that Shock/Fainting there is no immediate threat to life. Spinal Injuries

Call 000 or mobile 112 for an Sprains/Strains/Bruises ambulance. Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 18 BABY resuscitation 2 of 5 Adult Resuscitation Adult Defibrillation - Check that the baby’s nose is clear 5 If the baby is breathing Child Resuscitation and quickly wipe away any mucus or normally other discharge that could obstruct Baby Resuscitation the movement of air. • Adjust the recovery position if necessary to ensure stability. Special Resuscitation A small baby breathes through the nose in the early stages of • Cover the baby with a blanket in CPR Chart development and a blocked nose cool weather or a light covering in can cause a serious obstruction hot weather. Abdominal Injuries • With your lower hand support the • Check the airway and signs of life Asthma jaw and lift the chin slightly to ensure every few minutes and be prepared that the tongue is held forward in to begin CPR if normal breathing Allergic Reaction the mouth. Because the tongue is stops. attached to the back of the lower jaw, Bites and Stings this simple movement will prevent the tongue from falling backwards to block Bleeding the throat. Avoid head tilt for a baby Burns and Scalds but make sure that the face is pointing slightly downwards. Chest Injuries In a baby it is vital to maintain Childbirth/Miscarriage jaw support because of the large amount of soft tissue in Choking the mouth and throat, which can cause an airway obstruction. Cold Illness Convulsions/Seizures 4 Check for breathing Croup • When the airway is clear and open: ~ Look for movement of the lower chest Diabetes and upper abdomen. Drug/Alcohol Overdose ~ Listen for the escape of air from the baby’s mouth or nose. Eye Injuries ~ Feel for movement of the lower chest and abdomen and for the escape of air If the baby is NOT breathing Fractures/Dislocations from the baby’s mouth or nose. 6 normally Head Injuries ~ Check for normal breathing but ignore occasional gasps which are • If necessary, quickly roll the baby onto Heart Conditions inadequate to maintain life. the back to begin CPR. • First locate the centre of the chest, Heat Illness checking that your hand is on the Hyperventilation baby’s sternum (breastbone) and not below it on the abdomen. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Avoid compressing too high or Poisoning too low by quickly finding the notch where the ribs meet in Shock/Fainting the centre. Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 19 BABY resuscitation 3 of 5 Adult Resuscitation Adult Defibrillation Child Resuscitation

• With your fingers follow up the borders 7 Compress the sternum Baby Resuscitation of the rib cage to the middle of the • To give compressions, keep your finger Special Resuscitation chest and identify the notch where the tips on the chest to exert downward ribs meet in the centre. CPR Chart pressure through the sternum without any pressure on the rib cage. Abdominal Injuries Stay close to the side of the baby, with your fingers directly above the Asthma sternum. Allergic Reaction Bites and Stings Bleeding Burns and Scalds Chest Injuries Childbirth/Miscarriage Choking Cold Illness Convulsions/Seizures • Mark this notch with an index finger and place two fingers just above it, Croup which will be over the lower half of the sternum. • Compress the sternum by pushing Diabetes downwards to depress the breastbone to one-third of the depth of the chest. Drug/Alcohol Overdose When resistance is felt, no further Eye Injuries pressure should be applied, but the arm should relax as the compression Fractures/Dislocations ceases. Head Injuries •The first aider should maintain these compressions at the rate of Heart Conditions approximately 100 - 120 per minute until 30 compressions have been given. Heat Illness • Immediately follow the compressions Hyperventilation with two puffs of rescue breathing and then give a further 30 Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED compressions. Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 4 FIRST AID EMERGENCY eHANDBOOK 5th ed 20 BABY resuscitation 4 of 5 Adult Resuscitation Adult Defibrillation Child Resuscitation 8 Rescue Breathing Baby Resuscitation • Begin rescue breathing using the Special Resuscitation mouth-to-mouth-and-nose method of resuscitation. CPR Chart • Hold the baby’s head level with your Abdominal Injuries upper hand and support the jaw with chin lift using your lower hand. Use Asthma the “Pistol Grip” to maintain control of the jaw. Allergic Reaction Bites and Stings Bleeding Burns and Scalds Chest Injuries • Remove your mouth from the baby’s face and turn your head sideways to Childbirth/Miscarriage listen to the escape of air and watch the chest empty. Be careful to avoid Choking inhaling the baby’s expired air. Cold Illness Convulsions/Seizures Croup Diabetes Avoid head tilt on a baby Drug/Alcohol Overdose because this can obstruct the airway and may cause Eye Injuries unnecessary stress to the neck spine. If there is resistance to Fractures/Dislocations each breath, try a gentle head tilt until an even flow of air is Head Injuries achieved. Heart Conditions

• Take a small breath in and seal the Heat Illness baby’s mouth and nose with your mouth. Puff gently into the baby’s Hyperventilation mouth until the chest rises, as for • When the chest is empty, repeat these Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED normal breathing. steps one more time to give a total of two puffs, allowing about one second Poisoning for each one. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 5 FIRST AID EMERGENCY eHANDBOOK 5th ed 21 BABY resuscitation 5 of 5 Adult Resuscitation Adult Defibrillation Child Resuscitation It is easy to breathe too hard When to stop resuscitation into a small baby and some 11 Baby Resuscitation distension of the abdomen • Resuscitation should continue until: Special Resuscitation may be seen. If this occurs, ~ the baby recovers simply turn the baby into the recovery position and clear ~ qualified help arrives and takes over CPR Chart care of the baby and open the airway again. Abdominal Injuries If the stomach is distended ~ an authorised person pronounces that with air, it will be expelled life is extinct Asthma during the change of position. Then turn the baby onto the ~ the first aider is unable to continue, Allergic Reaction back once more and continue usually due to exhaustion. resuscitation efforts. Bites and Stings

Pressure should not be applied Bleeding over the stomach or abdomen because this can lead to Burns and Scalds regurgitation of stomach Chest Injuries contents with the risk that some material may be inhaled Childbirth/Miscarriage into the lungs, causing fatal complications. Choking Cold Illness 9 Re-check for signs of recovery Convulsions/Seizures • Check for signs of recovery including normal breathing or coughing. Croup Diabetes 10 If signs of recovery are seen Drug/Alcohol Overdose • Turn the baby on the side into the recovery position and make further Eye Injuries checks every two minutes until the baby either regains consciousness and Fractures/Dislocations responds to your voice or touch, or an Head Injuries ambulance arrives. Heart Conditions An AED should not be used for Heat Illness a baby because a manual unit is required and only in skilled Hyperventilation hands. A manual unit allows the operator to "dial up" a Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED precise shock with energy based on the baby's weight Poisoning and development. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 22 1 of 2 Adult Resuscitation Adult Defibrillation Resuscitation in special Child Resuscitation circumstances Baby Resuscitation Special Resuscitation Resuscitation in water Resuscitation for a victim with a CPR Chart laryngectomy stoma • If a person falls overboard from a boat Abdominal Injuries or gets into difficulties while swimming, the rescuer or first aider should take Background Asthma special care to avoid injury during any A person who has had surgery for cancer of the rescue attempt. If the victim is in deep larynx (voice box) may have lost all or part of the Allergic Reaction water, only a very strong swimmer who airway section between the throat and lower is supported by a good flotation device windpipe. In such cases the victim may have a Bites and Stings should attempt rescue and resuscitation. breathing hole (stoma) in the neck through which breathing occurs. Air will only be heard escaping Bleeding • Before any resuscitation attempts are through the mouth if the victim has had a partial made, the victim should be towed to laryngectomy in which there is still some air Burns and Scalds connection between the throat and the windpipe. shallow water where the rescuer can stand. Chest Injuries

• When giving rescue breathing, if a stoma Childbirth/Miscarriage is present the first aider may not see the chest rise with each breath, although Choking the air seems to enter the mouth and throat efficiently. The first aider may even Cold Illness feel or hear air escaping from the neck Convulsions/Seizures region following each breath of rescue breathing. If this occurs when there is Croup a good seal over mouth and nose, the first aider should check the neck for the Diabetes presence of a stoma. Drug/Alcohol Overdose • Once in shallow water the rescuer may • If a stoma is found the first aider should commence rescue breathing if trained give rescue breaths through that hole and Eye Injuries to do so. The victim’s head needs to be watch for the rise and fall of the chest as supported with your arm around and before. If an inner tube is seen inside the Fractures/Dislocations under the shoulders, keeping the face stoma it should be left in place because clear of the water. it is maintaining an open airway. Head Injuries • The mouth-to-nose technique is best Heart Conditions because it is easier to maintain a good seal while keeping the first aider’s face Heat Illness out of water. The victim’s mouth should be closed firmly during each ventilation Hyperventilation to avoid air escaping. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED • As soon as it is possible to move the victim from water, clear and open the Poisoning airway with the victim on the side, then turn the victim on the back and start CPR Shock/Fainting if necessary. Spinal Injuries • After giving 30 compressions give two rescue breaths as for any other collapsed • All other resuscitation steps are the same Sprains/Strains/Bruises victim. Continue until victim recovers or as for any adult victim — see Resuscitation. help arrives. Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 23 Special resuscitation 2 of 2 Adult Resuscitation Adult Defibrillation Resuscitation during the last Child Resuscitation weeks of pregnancy Baby Resuscitation • If CPR is needed, the compressions Special Resuscitation Background should be applied as for any other During the final weeks of a pregnancy, or collapsed victim. In a short victim where CPR Chart even earlier if a woman is pregnant with the shoulders have been raised slightly twins or triplets, there may be great pressure off the ground by the padding under the Abdominal Injuries on the stomach, diaphragm and lungs caused right buttock, the first aider should adjust by the growing baby. If collapse occurs at this Asthma time there may be complications if standard the compression technique to ensure that pressure is directed from the lower resuscitation techniques are used. For this Allergic Reaction reason a modified approach is needed. half of the sternum straight through to the spinal column. When giving rescue Bites and Stings breaths there may be added resistance to • If the pregnant woman is unconscious, each breath because of the bulk of the Bleeding she should always be turned on her side baby under the diaphragm. to clear and open her airway because Burns and Scalds of the serious risk of regurgitation from pressure of the baby on her stomach. • If CPR is not required, or if the victim Chest Injuries recovers after resuscitation has been • If there are no signs of normal breathing, given, she should be turned into the Childbirth/Miscarriage she should be turned onto her back for recovery position but only onto her left CPR but padding is needed under her side to avoid pressure on the deep vein Choking right buttock to tilt her hips slightly to on the right side of her abdomen. the left. This is known as the Left Lateral Cold Illness Tilt technique and it effectively moves the bulk of the baby off the mother’s deep Convulsions/Seizures vein on the right side of her abdomen (the inferior vena cava), allowing free Croup movement of blood back to the heart. Diabetes Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions Heat Illness Hyperventilation If necessary, a bystander may be asked to gently pull the bulging Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

abdomen across to the left side. Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 24 1 of 1 Adult Resuscitation Adult Defibrillation CPR Summary Chart Child Resuscitation Baby Resuscitation Special Resuscitation ADULT 3CHILD BABY CPR Chart older CHILD 31 to 8 yrs up to 1 yr Abdominal Injuries CPR ratios for 1 30 compressions 30 compressions 30 compressions Asthma person to 2 breaths to 2 breaths to 2 puffs Allergic Reaction Bites and Stings CPR ratios for 2 30 compressions 30 compressions 30 compressions Bleeding persons to 2 breaths to 2 breaths to 2 puffs Burns and Scalds Chest pressure 2 hands 1-2 hands 2 fingers Chest Injuries Childbirth/Miscarriage CPR compression rate Approximately Approximately Approximately Choking 100 - 120 per minute 100 - 120 per minute 100 - 120 per minute Cold Illness

Compression depth One-third of One-third One-third of Convulsions/Seizures chest depth of chest depth chest depth Croup Diabetes Head tilt Maximum Minimum None Drug/Alcohol Overdose Eye Injuries Rescue breaths 2 full breaths 2 small breaths 2 puffs Fractures/Dislocations

Breathing rate 1 breath 1 small breath 1 puff Head Injuries in 1 second in 1 second in 1 second Heart Conditions Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 25 1 of 1 Adult Resuscitation Adult Defibrillation Symptoms and signs Abdominal • History of injury to the abdominal area Child Resuscitation • Bleeding wound or other obvious injury, Baby Resuscitation injuries possibly with visible intestines • Severe pain and possible muscle spasm Special Resuscitation across the abdominal wall Background • Nausea or vomiting CPR Chart The abdominal cavity lies below the rib cage • Symptoms and signs of shock — see Shock and above the pelvic cavity. Unlike the chest Abdominal Injuries • Bruising of the skin and pelvic cavities, there are no bones to protect the abdomen and any injury may • Victim unable to stand and holding the Asthma cause serious damage to some of the injured area for pain relief abdominal organs, including the liver, spleen • Victim shows other indications of internal Allergic Reaction or stomach. In some cases, the injury may bleeding — see Internal Bleeding involve both the abdominal and pelvic Bites and Stings contents. If this occurs, the injured victim may bleed to death internally unless urgent Bleeding hospital treatment is available. 2 Control bleeding and cover any Burns and Scalds wound • Hold the wound edges together to Chest Injuries What to do — step by step control bleeding. Sometimes the victim Childbirth/Miscarriage can change position slightly to help the 1 Place victim at total rest and wound to close. Choking assess the injury • If the intestines are visible, do not touch or try to replace them. Cold Illness • Assist the victim to lie down in a position • Cover a gaping wound with sterile of greatest comfort, usually on the back or Convulsions/Seizures dressings soaked in warm water to avoid else on the uninjured side, with both knees damage to organs. drawn up for relief of pain and spasm. Croup • Firmly and gently hold the dressing in • Loosen any tight clothing, especially at place with wide crepe bandages around Diabetes waist and neck. Support the victim with the trunk, without applying pressure. pillows and blankets for comfort, as Drug/Alcohol Overdose needed. Give frequent reassurance. Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions Do not allow the victim to eat, drink or smoke while waiting for Heat Illness the ambulance because an anaesthetic is likely to be needed. Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED 3 Observe the victim • While waiting for the ambulance to Poisoning • Check the area for signs of injury. arrive, observe the victim for any changes Shock/Fainting in condition. Call 000 or mobile 112 for an • Check the level of consciousness every Spinal Injuries ambulance, unless the injury is few minutes. In the conscious victim an minor, e.g. winding after a blow increasing pulse rate is a sign of internal Sprains/Strains/Bruises to the abdomen. bleeding and urgent medical care is needed. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 26 1 of 1 Adult Resuscitation Asthma What to do — step by step Adult Defibrillation Child Resuscitation Background 1 Help the victim to rest Asthma is a lung condition in which breathing • Help the victim into Baby Resuscitation becomes difficult because of inflammation of a sitting position, the air passages. The airways become Special Resuscitation narrowed by muscle spasm, swelling and but with support. increased mucus production, often causing a • Ideally, allow the arms CPR Chart wheeze to be heard. Air is trapped in the to rest on a table to lungs by the swollen airways and the victim increase the rib spaces. Abdominal Injuries has most difficulty breathing out. A cold, influenza or other chest infection Asthma may trigger an asthma attack. The other Do not allow any physical activity. most common triggers are an allergic reaction Allergic Reaction to a pollen, dust or animal product, or to exercise, especially in cold weather. 2 Assist with prescribed medication Bites and Stings The victim of asthma should be taking prescribed Bleeding medication to avoid an asthma attack. These • Help the victim to take any prescribed “Reliever” medication drugs are called “Preventers” and are colour- Burns and Scalds coded in shades of red, brown and gold. as soon as possible. If a spacer is available, During an asthma attack, the victim can take a Chest Injuries prescribed “Reliever” medication, preferably the victim should use it through a “Spacer” device, which helps to hold to take the medication, Childbirth/Miscarriage the medication and overcome the difficulty of one puff at a time. inhaling it during an attack. Reliever containers Choking are colour-coded in shades of grey or blue, and the medication quickly relaxes airway spasm. Cold Illness Convulsions/Seizures Croup Diabetes Drug/Alcohol Overdose

• Give four puffs of the medication with Eye Injuries Preventers four breaths between each puff and then repeat this dose after four minutes if no Fractures/Dislocations improvement has occurred. Head Injuries Call 000 or mobile 112 for an ambulance. Heart Conditions • Continue to assist the victim with Heat Illness

Relievers four puffs every four minutes until an ambulance arrives. Hyperventilation Symptoms and signs • If a spacer is not available a disposable • Breathlessness and difficulty speaking more Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED than a few words without a gasp of air polystyrene foam cup could be used, with a hole cut in the base to insert the puffer. Poisoning • Wheezing sometimes, but not always • Persistent cough, often moist and “rattling” Shock/Fainting • Poor skin colour, especially blueness of lips 3 Follow-up care and fingertips • If improvement occurs, keep the victim at Spinal Injuries • Obvious breathing effort with pulling-in of rest until the skin colour is normal. If the Sprains/Strains/Bruises the rib spaces victim is a child, ensure that the parents • Rising pulse rate are informed of the attack and advise a Stroke medical check with the family doctor. Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 27 1 of 2 Adult Resuscitation Adult Defibrillation Allergic Child Resuscitation reaction Baby Resuscitation Special Resuscitation Anaphylactic shock CPR Chart What to do — step by step Abdominal Injuries

Background Stay with the victim and Asthma Some people are severely allergic to certain 1 foods, chemicals and medications, or to ensure total rest Allergic Reaction injected venoms following a bite or sting. •If an allergic reaction is developing, the An allergic reaction can be very severe, and victim may suddenly collapse and urgent Bites and Stings sometimes is fatal within a matter of minutes CPR may be needed — see Bleeding if prompt medical treatment is not available. Resuscitation. Peanuts in any form are the most common Burns and Scalds food item that can cause a severe life Call 000 or 112 for an ambulance: threatening allergic reaction in a sensitive  Chest Injuries individual. Many children are severely allergic • if the casualty is known to have to peanuts, and parents, child carers and an allergy problem, or Childbirth/Miscarriage teachers need to ensure that there is no accidental contact through eating a friend’s • if the reaction involves any Choking lunch. Others react severely to antibiotics breathing difficulty. such as penicillin. Cold Illness 2 Keep the victim at total rest These severe allergic reactions are known as Convulsions/Seizures anaphylactic shock because the body • Rest can slow the onset of a serious develops severe shock after the substance reaction and allow time for help to arrive. enters the body. The reaction may vary from Croup a body rash and slight wheezing, through to • Help the victim to lie down. If there are Diabetes collapse and death. For a known allergy a breathing difficulties, keep the head and doctor may prescribe some medication to be chest raised. Drug/Alcohol Overdose taken at the first sign of a reaction, usually in the form of a self-administered adrenaline Eye Injuries injection through an ‘EpiPen’. 3 Assist with any prescribed medication or treatment Fractures/Dislocations • Some allergic casualties carry prescribed Head Injuries Symptoms and signs medication in the form of a tablet, puffer spray or a self-administered injection of Heart Conditions • Swelling of the face, especially around the adrenaline (EpiPen). If necessary, assist mouth, throat and eyes the victim to administer their prescribed Heat Illness • Swelling of the affected area if there has dose of medication. been contact with a chemical or venom Hyperventilation • Redness of the skin or an itchy rash over the chest and back Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED • Nausea and/or vomiting Poisoning • Breathing difficulty similar to an asthma attack — see Asthma Shock/Fainting • Dizziness, weakness or collapse Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 28 Allergic reaction 2 of 2 Adult Resuscitation Adult Defibrillation Child Resuscitation • To administer an EpiPen, hold it with a 4 If the reaction follows exposure fist grip, remove blue cap and then hold to a chemical Baby Resuscitation the orange end against the outer thigh and push down HARD. After a click is • Wash the contact area thoroughly with Special Resuscitation heard, hold the pen in place for a full 3 copious amounts of running water. seconds before removal. CPR Chart Abdominal Injuries The EpiPen should not be stabbed Asthma into the thigh. When pressed firmly against the outer thigh it Allergic Reaction will activate automatically. Bites and Stings Bleeding Burns and Scalds Chest Injuries Childbirth/Miscarriage Choking Cold Illness 5 Observe the casualty closely Convulsions/Seizures • While waiting for the ambulance to Croup arrive, observe the casualty closely for any change in condition, including: ~ Diabetes level of consciousness Drug/Alcohol Overdose ~ breathing rate ~ pulse rate Eye Injuries Be prepared to use a second auto-injector • Fractures/Dislocations if one is available and if the victim deteriorates before the ambulance arrives. Head Injuries • If the victim also has breathing Heart Conditions difficulties, give an asthma "Reliever" puffer through a spacer — see Heat Illness Asthma. Hyperventilation • Be prepared to begin resuscitation if necessary — see Resuscitation. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

• The used Epipen should be passed to Poisoning the ambulance crew members for safe disposal. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 29 1 of 6 Adult Resuscitation Bites and stings Adult Defibrillation Child Resuscitation Background Bites and stings that Baby Resuscitation Bites are made by an animal jaw or mouth need special care parts, e.g. a dog, spider or snake. An animal Special Resuscitation uses stinging apparatus combined with the injection of venom, e.g. jellyfish, bee or wasp. Funnel Web spider bite In some animals the injury is a combined bite CPR Chart and sting, e.g. Funnel Web spider, Blue-ringed octopus. Even small animals can inject All Australian spiders have fangs and venom Abdominal Injuries enough venom to kill a baby or small child, sacs and are capable of giving a painful bite. e.g. a Funnel Web spider or snake. However, only the Sydney Funnel Web spider Asthma venom poses a threat to life with the rapid Often antivenom may be given to reverse the onset of breathing difficulties. In and around Allergic Reaction effects of the poison. Sydney and northern New South Wales a bite from any large and dark coloured spider Bites and Stings should be treated as a possible Funnel Web Symptoms and signs spider bite and urgent Bleeding • Pain (moderate or severe, depending on the medical care obtained. animal involved) If the spider can be Burns and Scalds • Swelling or deformity of the bite or sting area safely captured, it can help later identification. • Discolouration of the affected area Chest Injuries Funnel Web spider • Altered sensation, e.g. numbness or “pins antivenom is available. Childbirth/Miscarriage and needles” if a nerve pathway is affected • Nausea or vomiting Choking • Headache What to do — step by step Cold Illness • Blurred or double vision • Muscle weakness or paralysis Convulsions/Seizures If bitten on limb apply the • Breathing difficulty 1 Pressure Immobilisation Croup Bandaging Technique General management Diabetes Pressure Immobilisation Bandaging 1 Place victim at total rest Technique Drug/Alcohol Overdose •Select a 5cm elasticised crepe bandage • Rest will reduce the effects of shock and Eye Injuries for a small limb, or 7.5cm crepe bandage also slow down the absorption of venom for a large limb and apply it over the bite into the circulation if a venomous animal Fractures/Dislocations site as firmly as for a sprained ankle. is involved. Head Injuries • Give frequent reassurance to lessen the effects of the bite or sting. Heart Conditions Heat Illness

• Apply a second elasticised crepe bandage Hyperventilation (5cm or 10cm wide) over the whole limb. Start applying the bandage at the toes or Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

fingertips and work upwards around the Poisoning Call 000 or mobile 112 for an limb. Try to cover the limb up to the knee ambulance. or elbow, and higher if possible. Shock/Fainting If in remote area, contact the Royal Spinal Injuries Flying Doctor Service (RFDS) as soon as possible so that telephone advice or a Sprains/Strains/Bruises medical evacuation can be arranged promptly. Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 30 Bites and stings 2 of 6 Adult Resuscitation Adult Defibrillation Immobilise the limb Snake bite • If bitten on the leg, use the other leg as a Child Resuscitation splint. Pad between the legs with clothing Some of the most venomous snakes in the or a blanket, and tie one leg to the other world are found in Australia and all are Baby Resuscitation at the ankles, lower legs and knees. capable of delivering venom that can result in serious illness or even death. Unless you Special Resuscitation are certain the snake is non-venomous, it is always wise to treat any snake bite as CPR Chart venomous. This is vital in a remote area where professional help may be several Abdominal Injuries hours away and the correct first aid can be lifesaving. Antivenom is available for all snake Asthma • If bitten on the arm or hand, apply a bites in Australia. splint to the lower arm, and apply an arm Allergic Reaction sling — see Skills and procedures, Slings. Bites and Stings • Once the immobilisation has been What to do — step by step completed, keep the victim quiet and Bleeding comfortable until an ambulance arrives. Apply the Pressure 1 Burns and Scalds • Once applied, the bandages and splinting Immobilisation Bandaging should not be removed until the victim Technique — see technique. Chest Injuries reaches hospital or a treatment centre. Check with the victim at intervals to see • Keep the victim lying down at total rest. Childbirth/Miscarriage that the bandages are not too tight. If there Call 000 or mobile 112 for an is increasing pain in the toes or fingers, it ambulance. Choking may be necessary to loosen the bandages. • Check regularly that the bandages are not Cold Illness Call 000 or mobile 112 for an too tight because any movement by the ambulance. victim to get comfortable may encourage Convulsions/Seizures more venom to enter the circulation. Once • Check regularly that the bandages are Croup not too tight because any movement applied, leave the bandage in place. by the victim to get comfortable may Keep the bitten limb level with Diabetes encourage more venom to enter the the rest of the body to avoid circulation. venom rapidly entering the system Drug/Alcohol Overdose through gravity. If the bitten limb Eye Injuries Keep the bitten limb level with is lower than the rest of the body, the rest of the body to avoid swelling is likely to occur. venom entering the system rapidly. Fractures/Dislocations If the bitten limb is lower than the rest The Pressure Immobilisation Head Injuries of the body swelling is likely to occur. Bandaging Technique will slow down the absorption of venom into Heart Conditions The Pressure Immobilisation the circulation, which will allow the Bandaging Technique will slow lymphatic system to de-toxify it Heat Illness down the absorption of venom into — see Lymphatic system. the circulation, which will allow the Hyperventilation lymphatic system to detoxify it — see Lymphatic system. 2 Observe the victim closely Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED • While waiting for the ambulance to 2 Observe the victim closely arrive, observe the victim closely for any Poisoning change in condition, including pulse rate, Shock/Fainting • While waiting for the ambulance to breathing rate and level of consciousness. arrive, observe the victim closely for any Be prepared to begin resuscitation if Spinal Injuries change in condition, including pulse rate, necessary — see Resuscitation. breathing rate and level of consciousness. Sprains/Strains/Bruises Be prepared to begin resuscitation if necessary — see Resuscitation. Stroke Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 31 Bites and stings 3 of 6 Adult Resuscitation Other spiders, ant and Bee or wasp stings Adult Defibrillation centipede bites Child Resuscitation Bees have only one stinging barb Other spider bites may cause pain and illness that is left in the skin following Baby Resuscitation to a baby or small child, but are not a threat the incident. The venom sac is to life in normal circumstances. A Red Back attached to the barb and continues Special Resuscitation spider bite can cause a severe illness to a to inject venom until it is empty. baby or small child but is not associated with For this reason the barb should be CPR Chart the sudden deterioration of the victim, which removed as soon as possible. occurs with a Funnel Web Abdominal Injuries spider bite. The European Wasp does not leave a detached barb in the skin Recent Australian research but inflicts multiple stings, Asthma has proved that a White- thus increasing the amount of tail spider bite may be venom injected. Allergic Reaction very painful but the venom does not cause ulceration of the skin as commonly feared. The danger with bee and wasp stings is that Bites and Stings stings around the mouth, throat or face can swell and cause airway obstruction. Also, Bleeding What to do — step by step some people have an allergic reaction to bee venom and may collapse within two or Burns and Scalds three minutes after being stung, requiring Apply cold treatment 1 resuscitation and urgent medical treatment. Chest Injuries • Apply a wrapped ice pack for up to 10 minutes at a time, or a cold compress that Childbirth/Miscarriage has been soaked in water to which a few What to do — step by step ice cubes have been added. The ice pack Choking should be wrapped in a damp cloth to get Remove the barb Cold Illness the best effect from the ice and to avoid 1 burning the skin. A cold compress should • If stung by a bee, quickly brush or scrape Convulsions/Seizures be changed whenever it becomes warm. the barb off the skin to stop any more venom being injected. Brush the barb off Croup sideways using a fingernail or the side of your hand. Avoid pulling or squeezing Diabetes the barb, as this will cause more venom to be injected. Drug/Alcohol Overdose

If known to be allergic to bee Eye Injuries or wasp venom, administer an Fractures/Dislocations EpiPen as soon as possible — see Allergic Reaction. Head Injuries Heart Conditions 2 Elevate a bitten limb 2 Apply cold treatment • If the bite is on a limb, raise it to limit • Immediately apply a wrapped ice pack to Heat Illness swelling. If an arm or hand is involved, the bite site and leave it in place for up Hyperventilation apply an Elevation Sling to provide to 10 minutes. Reapply the ice pack for comfort and support — see Skills and up to 10 minutes at frequent intervals or Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED whenever pain relief is needed.

procedures, Slings. Poisoning Seek medical advice Raise the bitten area 3 3 Shock/Fainting Seek prompt medical advice if the • Raise the bitten area as high as possible victim is a baby or young child, or if to limit the swelling that will occur. Spinal Injuries the pain becomes severe or the victim • If an arm or hand has been stung, apply becomes ill with a fever, headache, Sprains/Strains/Bruises an Elevation Sling to provide comfort nausea or vomiting. and support — see Skills and procedures, Stroke Slings. Skills and Procedures

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© 201 © INDEX 4 FIRST AID EMERGENCY eHANDBOOK 5th ed 32 Bites and stings 4 of 6 Adult Resuscitation 4 Seek medical advice 2 If medical care is not readily Adult Defibrillation available Contact the local doctor for advice. If Child Resuscitation the victim is known to be allergic to • Try to remove the tick. Use fine tweezers Baby Resuscitation the venom, give an EpiPen dose and on either side of the tick and lever it out apply the Pressure Immobilisation of the skin. Check that the head and Special Resuscitation Bandaging Technique. mouthparts are completely removed with the body of the tick because inflammation CPR Chart Seek urgent medical assistance and infection will result from mouthparts  drive the victim to the nearest left embedded in the skin. Abdominal Injuries doctor or hospital before any complications occur. • Seek medical advice as soon as possible in case follow-up care is required. Asthma • Observe the victim closely for any change Allergic Reaction in condition. • If any of the warning signs of an allergic Cat or dog bite Bites and Stings reaction appear, send for an ambulance urgently. The warning signs include a fine Bleeding Domestic animal bites usually cause an rash over the trunk, wheezing or coughing, Burns and Scalds or swelling around the face, eyes and infected wound. Although the wound may neck — see Allergic Reaction. be small, medical advice is usually needed, and antibiotics are often prescribed and a Chest Injuries protective tetanus injection given. Tick bite Childbirth/Miscarriage Choking What to do — step by step Ticks are very small creatures that attach Cold Illness themselves to human or animal skin to feed off blood. The one that attaches to human 1 Control any bleeding Convulsions/Seizures skin is the Paralysis Tick, which is found on • If the wound is bleeding freely, or is on the east coast of Australia from northern the face, apply a firm pad and hold in Croup Queensland to the eastern Victorian rain place — see Bleeding. forest area. Diabetes A tick is small and very hard to Seek urgent medical advice and see unless it is full of blood. Most treatment. Drug/Alcohol Overdose exist in a skin fold or hidden in body hair. A person with a tick may become Eye Injuries ill as the tick toxin enters the body. The 2 Clean a minor wound thoroughly illness develops over several days and Fractures/Dislocations paralysis may occur if the tick is not found at • Use warm soapy water to remove any an early stage. The toxin is particularly harmful organisms. Head Injuries serious for a baby or small child and people • If the injury is a deep puncture wound, who live in tick infested areas need to be soak the area in warm soapy water to Heart Conditions suspicious of tick toxin as the cause of an unexplained illness. ensure that the deeper area is cleaned. Heat Illness Harmful tetanus spores can be trapped inside the wound and will multiply when Hyperventilation What to do — step by step the wound closes over and oxygen is cut off to those tissues. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

1 Locate the tick • Apply a sterile protective dressing. Poisoning • Look in all the skin folds, body hair and • Seek medical advice. other areas such as behind the ears and Shock/Fainting in the hairline. Spinal Injuries • Seek urgent medical advice and treatment, especially for a baby or small child. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 5 FIRST AID EMERGENCY eHANDBOOK 5th ed 33 Bites and stings 5 of 6 Adult Resuscitation Marine bites Adult Defibrillation and stings Child Resuscitation Marine bites and stings Baby Resuscitation Special Resuscitation There are many marine animals that bite or sting and some of them may cause serious • Apply vinegar freely over areas that have CPR Chart illness or even death. The most dangerous marine animals are found in tropical been stung to neutralise the venom. Abdominal Injuries waters, generally considered to be north of Rinse the area with sea water (not fresh Geraldton on the west coast and north of water) as necessary for pain relief. Reassure Asthma Bundaberg on the east coast of Australia. the victim frequently and try to maintain a The correct first aid calm approach until an ambulance arrives. Allergic Reaction can be lifesaving for Bites and Stings the victim of a bite Observe the victim closely or sting from a 3 marine animal off • While waiting for the ambulance to arrive, Bleeding a remote beach in observe the victim closely for any change a tropical area. in condition, including pulse rate, Burns and Scalds breathing rate and level of consciousness. Be prepared to begin resuscitation if Chest Injuries Box Jellyfish and necessary — see Resuscitation. Childbirth/Miscarriage Irukandji Jellyfish stings Antivenom is available for the Box jellyfish. Choking What to do — step by step For specific advice on marine stings Cold Illness in an emergency, call the Australian Convulsions/Seizures 1 Douse with vinegar Venom Research Unit (AVRU) on the 24-hour advice line 03 9483 8204. Croup • Stop the victim from rubbing the stung area. • Flood all affected areas of skin with house- All other jellyfish stings outside Diabetes hold vinegar to prevent further envenomation tropical waters from unfired stinging cells (nematocysts). Drug/Alcohol Overdose Eye Injuries What to do — step by step Fractures/Dislocations 1 Remove tentacles from Head Injuries the skin Heart Conditions • Stop the victim from rubbing the stung area in an effort to relieve the pain. Heat Illness • With your fingers pick off any tentacles Hyperventilation that have been left on the skin to Call 000 or mobile 112 for an prevent further stings, then rinse well Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED ambulance. with sea water. • Unless it is a minor sting with very little Poisoning pain, send for ambulance assistance. 2 Remove any remaining tentacles Shock/Fainting • Pick off any visible tentacles with your fingers. This is quite safe for the first aider. Do not fresh water or other Spinal Injuries fluids because this can cause • Keep the victim lying down at total rest. Sprains/Strains/Bruises Any movement by the victim may encourage firing of the remaining stinging cells in the loose tentacles. more venom to enter the circulation. Stroke Skills and Procedures

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© 201 © INDEX 6 FIRST AID EMERGENCY eHANDBOOK 5th ed 34 6 of 6 Bites and stings Adult Resuscitation 2 Apply ice packs for pain relief Stonefish, Stingray and Adult Defibrillation Bullrout stings Child Resuscitation • While waiting for ambulance assistance, apply wrapped ice packs or cold Baby Resuscitation compresses to the stung area. There are several fish that can cause injury • If pain relief is still needed after 10 to 15 by injecting venom through their spines. The Special Resuscitation stonefish, bullrout and stingray camouflage minutes, try using water as hot as the themselves well and, CPR Chart victim can tolerate, but avoid burning and being adapted to life seek ambulance assistance. on the sea floor, Abdominal Injuries inflict injury when a swimmer or someone Asthma Blue-ringed octopus bites and fishing in the area Cone Shell stings accidentally steps on the fish. Allergic Reaction The venom is toxic and generally causes severe pain within a few minutes. Bites and Stings The venom of the Blue- ringed octopus and Cone Bleeding Shell can cause paralysis of Burns and Scalds the chest muscles used for What to do — step by step breathing that may last for up to 48 hours. If prompt Chest Injuries resuscitation is given, the 1 Immerse the stung area in hot Childbirth/Miscarriage victim may survive until the water venom wears off. • Soak the stung area in a container of Choking water hot enough for the first aider to Cold Illness bear on their arm. Hot water can relieve What to do — step by step the pain but, if the pain becomes worse Convulsions/Seizures with heat, a wrapped ice pack can be 1 Apply the Pressure tried, although this is rarely necessary. Croup Immobilisation Bandaging Diabetes Technique 2 Obtain medical assistance Drug/Alcohol Overdose • Apply the Pressure Immobilisation For specific advice on marine stings Bandaging Technique immediately with in an emergency, call the Australian Eye Injuries the victim lying down at total rest — Venom Research Unit (AVRU) on the see Technique. 24-hour advice line 03 9483 8204. Fractures/Dislocations • Check regularly that the bandages are not too tight because any movement Antivenom is available for Stonefish Head Injuries by the victim to ease the pain may stings but needs to be given as soon as encourage more venom to enter the possible for the best effect. Heart Conditions circulation. A Stingray may leave the barb in Heat Illness the skin and medical assistance is Send someone to call 000 or Hyperventilation mobile 112 for an ambulance needed to remove it. The wound left by the Stingray is usually urgently. Mouth/Tooth Injuries contaminated and likely to become UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

infected. Medical assistance is Poisoning 2 Observe the victim essential to clean the wound to promote rapid healing. • Observe the victim closely for any sign Shock/Fainting of breathing difficulty. Spinal Injuries • If normal breathing fails, CPR must be commenced and continued until the Sprains/Strains/Bruises arrival of ambulance assistance — see Resuscitation. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 35 1 of 6 Adult Resuscitation • Encourage the victim to apply pressure Adult Defibrillation Bleeding to the wound if this is practical. • The pad should totally cover the wound Child Resuscitation with a small area of overlap. If no bulky External bleeding Baby Resuscitation pad is readily available, improvise with clean tissues or light coloured clothing Special Resuscitation Background folded into a pad. An open wound is any break in the skin. A CPR Chart closed wound is where there is injury to the soft tissues underneath the skin. The amount Abdominal Injuries of bleeding depends on the type and depth of the wound and varies depending on the blood vessels that have been injured. Asthma If an artery has been damaged, bleeding is Allergic Reaction generally severe with bright red spurts of blood. If a vein has been injured, the blood is Bites and Stings usually darker in colour and flows out constantly without any spurting. However, Bleeding bleeding may be severe and life-threatening if a large vein has been cut, e.g. the jugular Burns and Scalds vein in the neck. If a smaller capillary is involved following a Chest Injuries surface wound, bleeding will vary depending on the location, i.e. bleeding from the scalp Childbirth/Miscarriage often appears severe although the injury may be minor. Choking Cold Illness Symptoms and signs Convulsions/Seizures External bleeding 2 Raise the injured area • A wound with, or without, an embedded • If the wound is on a limb, raise it in a Croup foreign object supported position to reduce blood flow • Severe pain from skin surface wounds to the injured area. If an arm is injured, Diabetes • Bruising or discolouration under the skin apply an Arm Sling or Elevation Sling — Drug/Alcohol Overdose • Loss of normal function in the injured area see Skills and procedures, Slings. • Shock — see Shock. Try to avoid any direct contact with Eye Injuries Internal bleeding the victim’s blood or other body fluids. • Rapid and weak pulse • If bleeding is severe, do not waste time Fractures/Dislocations • Rapid and “gasping” breaths looking for suitable padding, but be prepared to use your hand to hold the Head Injuries • Increasing thirst wound together if the victim is unable to Heart Conditions • Signs of internal bleeding with frothy red do this unaided. blood coughed up from the lungs, blood- stained vomit like “coffee grounds”, red or • Although the use of disposable gloves Heat Illness rust-coloured urine, or dark faeces like tar will reduce the risk of cross-infection if bleeding is severe, do not waste time Hyperventilation finding and applying gloves while the What to do — step by step victim loses more blood. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

• If there has been any contact with blood Poisoning 1 Apply direct pressure to the or other body fluids, wash your hands or bleeding wound any blood splashed on the skin thoroughly Shock/Fainting with soap and water as soon as possible • Unless an obvious foreign body is after the incident. Spinal Injuries embedded in the wound, use a sterile or clean bulky pad and apply it firmly to the • If you are concerned about a possible risk Sprains/Strains/Bruises bleeding area with hand pressure. Apply of infection, ask advice from your doctor as a bandage to keep the dressing in place. soon as possible. Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 36 Bleeding 2 of 6 Adult Resuscitation 3 If a foreign body is embedded in Keep the victim at total rest Adult Defibrillation the wound 5 • Even if the injury involves the arm or upper Child Resuscitation • Do not remove it but apply padding on part of the body, the victim needs to be either side of the object and build it up at total rest for at least 10 minutes to help Baby Resuscitation to avoid pressure on the foreign body. control the bleeding. • There will be some degree of shock with Special Resuscitation any loss of blood and it is important to CPR Chart allow the victim to lie down as soon as possible with both legs raised. This will boost Abdominal Injuries the victim’s blood pressure by returning blood to the head and chest areas. Asthma Call for medical assistance. Allergic Reaction If the wound appears to be Bites and Stings minor and the victim is able to travel by car, arrange an urgent Bleeding appointment with a local doctor to assess and treat the injury. Burns and Scalds If the injury is severe or the victim Chest Injuries very shocked, call 000 or mobile 112 • Hold the padding firmly in place with for an ambulance. Childbirth/Miscarriage a roller bandage or folded triangular bandage applied in a criss-cross method • Check the victim’s level of consciousness, Choking to avoid pressure on the object. breathing and pulse rate every few minutes while waiting for the ambulance. Cold Illness • Note any changes and give your observations to the ambulance officers. Convulsions/Seizures Croup 6 If blood leaks through the pressure pad and bandage Diabetes • Apply a second pad over the first unless Drug/Alcohol Overdose the initial pad is full of blood, which will then reduce the pressure over the wound. Eye Injuries OR Fractures/Dislocations • For major uncontrolled bleeding quickly remove the blood-soaked pad and bandage Head Injuries • If no bandage is readily available, and replace with a fresh bulky pad and improvise with a sock, scarf or other item bandage. The continuing bleeding may Heart Conditions of clothing. Use a safety pin or adhesive be due to the pad slipping out of position Heat Illness tape to secure the bandage. when the first bandage was applied. Hyperventilation If the wound is on the head, 4 Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED chest or abdomen

• Place the conscious victim at rest lying Poisoning down in the position of greatest comfort. Shock/Fainting • If possible, ensure that the injured area is higher than the rest of the body Spinal Injuries — see Head injury, Chest injury or Abdominal injury. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 37 Bleeding 3 of 6 Adult Resuscitation Wounds that need • Place the inflated bag into a container or bucket of cold water to which several ice Adult Defibrillation special care cubes have been added. Child Resuscitation Amputation Baby Resuscitation Special Resuscitation Background If a shearing force or a sharp object has CPR Chart severed a finger, toe or limb, the correct emergency care may Abdominal Injuries result in the part being successfully being re- Asthma attached by a surgeon. It is vital to take great care Allergic Reaction of the severed part and to transport it to hospital • Discreetly transport the severed part to Bites and Stings with the victim. hospital by ambulance with the victim. Bleeding What to do — step by step Blast injury Burns and Scalds Call 000 or mobile 112 for ambulance Chest Injuries transport to hospital. Background A blast injury is caused by pressure waves Childbirth/Miscarriage Control any bleeding following an explosion from gas or a bomb. 1 Choking • Use a bulky pad and apply it firmly to the Occasionally a blast injury occurs in an Australian workplace or when children play raised bleeding area. with fireworks without realising the potential Cold Illness • As a last resort and only when direct consequences. pressure has failed, apply an arterial Convulsions/Seizures There may be surface bleeding from wounds tourniquet well above the bleeding site. caused by flying debris, but more serious Croup Use a firm, non-conforming bandage, internal injuries may have occurred. These which is at least 5cm wide, around the may be recognised by blood leaking from Diabetes injured limb, tightly enough to stop all the nose, ears or mouth, and by the victim circulation below the tourniquet. Once coughing up bright red frothy blood from a Drug/Alcohol Overdose applied the tourniquet should not be lung injury, or vomiting dark bloodstained removed and the time of application must fluid if the stomach or intestines have been Eye Injuries be given to the emergency personnel. injured — see Internal bleeding. A blast injury should be managed as for any Fractures/Dislocations A correctly applied tourniquet is other bleeding problem, with pressure and extremely painful and, for this reason, elevation for external wounds, and internal Head Injuries it should be used only as a last resort. bleeding treated by correct positioning and total rest — see Internal bleeding. Heart Conditions 2 Recover the severed part Heat Illness • Gently place it into a plastic bag. Seal the bag with a little air inside to protect the Hyperventilation severed part with a “cushion” of air. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 4 FIRST AID EMERGENCY eHANDBOOK 5th ed 38 Bleeding 4 of 6 Adult Resuscitation Crush injury Nose bleed Adult Defibrillation Child Resuscitation Background Background A crush injury occurs from compression of large A blow to the nose, flying at high altitude or Baby Resuscitation muscle groups and soft tissues by a heavy weight. scuba diving may all cause a bleeding nose. The most serious sites for a crush injury to occur For a child always check whether there is a Special Resuscitation are the head, neck, chest, abdomen and thigh. foreign body present, e.g. a bead or coin etc. CPR Chart If this has occurred, seek prompt medical advice and do not try to remove the object yourself Abdominal Injuries because this may cause further damage. Asthma If the bleeding may be due to a head injury, e.g. a fractured skull — see Head Allergic Reaction injuries. Call 000 or mobile 112 for an Bites and Stings ambulance urgently. Bleeding What to do — step by step Burns and Scalds What to do — step by step 1 Apply firm pressure, elevation Chest Injuries and rest Remove the crushing force 1 • The victim needs to hold the head well Childbirth/Miscarriage Call 000 or mobile 112 for an ambulance forwards and breathe through the mouth Choking  while pinching the flaps of the nostrils Remove the crushing force because together for 10 to 15 minutes. Cold Illness permanent tissue damage may occur • The victim must be sitting down and at before the arrival of an ambulance or total rest until the bleeding stops. Convulsions/Seizures rescue vehicle. Croup If the crushing force has been in place for some time, be prepared to give prompt Diabetes first aid, because removal of the crushing force may cause a sudden collapse or Drug/Alcohol Overdose deterioration in the victim’s condition. Eye Injuries 2 Treat the victim’s injuries Fractures/Dislocations • Once the crushing force has been • If bleeding continues after 20 minutes Head Injuries removed, assess and treat any injuries of pressure, contact the local doctor in order of their importance. promptly for advice and treatment. Heart Conditions • Control any bleeding with a sterile pad applied firmly to the injured area. Once the bleeding has stopped Heat Illness • Treat the victim for shock — see Shock. • Advise the victim to avoid blowing or Hyperventilation • Assist the victim into the position of picking the nose because this may restart greatest comfort and use soft padding the bleeding. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED to provide support for the injured part. • A small child should be encouraged to sit Poisoning • If a limb is involved, stabilise and still for up to half an hour to allow the clot immobilise the injured area — see to become firm prior to any play activities. Shock/Fainting Fractures and dislocations. Bleeding may take longer to • Check the victim’s vital signs at frequent stop if it is a very hot day or Spinal Injuries intervals and at least every 15 minutes. when a child has been highly Note any deterioration or change in active beforehand. Sprains/Strains/Bruises the victim’s condition and inform the Stroke ambulance officers on arrival. Skills and Procedures

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© 201 © INDEX 5 FIRST AID EMERGENCY eHANDBOOK 5th ed 39 Bleeding 5 of 6 Adult Resuscitation

Other wounds A laceration, incised Adult Defibrillation or avulsed wound Child Resuscitation — See also Rules for wound care. A sharp object causes a laceration, which may have a Baby Resuscitation jagged appearance. If the injury An abrasion (graze) is deep, e.g. following a stab Special Resuscitation wound, damage may be caused An abrasion is a surface wound that affects to nerves and to the muscle CPR Chart only the top layer of skin, and fat layers under the skin although it may be very and bleeding is often severe. Abdominal Injuries painful because of the An incised wound is a form of laceration but number of nerve endings has straight edges and usually involves only the Asthma involved. These wounds skin surface. It commonly follows injury with a sharp are often contaminated by dirt or gravel but knife and the bleeding may be severe depending Allergic Reaction rarely bleed heavily because only minor blood on the number of blood vessels involved. vessels are involved. Clear serous fluid often An avulsion occurs when Bites and Stings weeps from the wound surface and this a flap of skin is torn away may continue until some crusting has been from its normal position but Bleeding formed to seal the wound. remains partly attached to the body. If the avulsed part Burns and Scalds What to do — step by step is quickly replaced into its normal position, bleeding is Chest Injuries • Gently clean with warm soapy water. usually only minor. All three of these wounds are treated as for • If there are pieces of gravel embedded any external bleeding — see external bleeding. Childbirth/Miscarriage in the wound, ask the victim to try to Choking remove them while the area is soaking in soapy water. A puncture wound Cold Illness • If soaking is impossible, apply warm A sharp or pointed object, compresses to clean and soften the tissues. such as a piece of glass or Convulsions/Seizures a nail, causes a puncture • Dry the area well by blotting with gauze wound. If the foreign object Croup swabs or a pad of tissues. is still embedded in the wound, the bleeding may be Diabetes • Apply a protective layer of povidone- only minor because it is being iodine antiseptic solution and air dry. controlled by pressure from the object. The Drug/Alcohol Overdose major problem is the risk of infection deep inside • If a protective dressing is necessary, apply the wound, especially tetanus spores, which Eye Injuries a non-adherent sterile dressing and fix it are anaerobic, meaning that they multiply in an in place with a light roller bandage. environment that is not exposed to air. Fractures/Dislocations Head Injuries What to do — step by step A high velocity wound • Clean the wound with warm soapy water Heart Conditions A high velocity wound is to remove any harmful organisms. caused by a bullet or grease Heat Illness gun. If a firearm is involved • Apply povidone-iodine antiseptic solution there is often a small entry and allow it to penetrate the puncture Hyperventilation wound and a large exit track because tetanus spores may be wound where the missile trapped deep in the wound. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

exploded out of the skin. The missile may have caused • Allow the wound to dry thoroughly in Ltd. the air before covering it. Poisoning

Pty serious internal injuries as it

passed through the tissues, • If a protective dressing is needed, use a Shock/Fainting especially if an organ has been penetrated, porous adhesive dressing and change it e.g. lung, liver or kidney. Bleeding is often daily to keep the wound healthy and dry. Spinal Injuries Administration

severe from the exit wound, which may look like a crater where tissue has been lost. Contact the local doctor urgently for Sprains/Strains/Bruises Tyrrells advice about tetanus immunisation. and Stroke Ltd

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© INDEX 6 FIRST AID EMERGENCY eHANDBOOK 5th ed 40 Bleeding 6 of 6 Adult Resuscitation Internal bleeding 2 Observe the victim Adult Defibrillation • While waiting for the ambulance to Background arrive, manage the injury as required Child Resuscitation for that body area — see Head injury, Internal bleeding may follow a major blow to Baby Resuscitation the head, chest, abdomen or pelvis, such as Chest injury, and Abdominal injury. in an incident where the victim has fallen from • Observe the victim closely for any Special Resuscitation a height or has been struck by a vehicle. There change in condition. If deterioration may not be an obvious wound and internal occurs, the victim may breathe in short CPR Chart bleeding may be suspected by blood leaving gasps (known as “air hunger”) to try the body in vomit, sputum, urine or faeces Abdominal Injuries and increasing shock — see Shock. and obtain more oxygen. • Ensure that all restrictive clothing has Asthma been loosened, especially at the neck What to do — step by step and waist. Keep any bystanders well Allergic Reaction clear to allow the victim to breathe 1 Place the victim at total rest fresh air freely. Bites and Stings • Assist the victim into the position of • Check the victim’s level of consciousness Bleeding greatest comfort. and the breathing and pulse rates every few minutes and note your observations Burns and Scalds • Provide clothing or blankets for support if for the ambulance officers. Increasing necessary. breathing and pulse rates will indicate Chest Injuries • Cover the victim with a blanket to continuing bleeding and urgent medical maintain body heat. Place protective care is required. Childbirth/Miscarriage fabric underneath the victim if the surface is rough, cold or hot, e.g. a coat Do not allow the victim to eat, Choking if the victim is lying on a road. drink or smoke while waiting for the ambulance to arrive because Cold Illness Call 000 or mobile 112 for urgent an anaesthetic is likely to be  ambulance transport. needed. Convulsions/Seizures Croup Diabetes RECOGNITION OF INTERNAL BLEEDING Drug/Alcohol Overdose BLEEDING SEEN DESCRIPTION OF BLEEDING POSSIBLE SOURCE Eye Injuries Coughed up Bright red & frothy Lung or airway Fractures/Dislocations Vomited up Dark red/brown "coffee grounds" Stomach or intestines Head Injuries From the mouth Fresh blood Mouth or jaw injury Heart Conditions From the nose 1. Fresh blood Nose injury 2. Straw-coloured fluid Fractured skull Heat Illness

From the ear 1. Fresh blood Injury to ear canal or drum Hyperventilation 2. Straw-coloured fluid Fractured skull Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Ltd. From the rectum 1. Fresh blood Haemorrhoids (piles) Poisoning Pty

2. Dark, "tarry" faeces Intestines Shock/Fainting Passed in urine 1. Dark, blood-stained urine Kidney Spinal Injuries Administration 2. Fresh blood or clots Bladder or urethra Sprains/Strains/Bruises Tyrrells From the vagina Heavy bleeding with clots Menstrual flow or miscarriage and Stroke Ltd

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© INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 41 1 of 4 Adult Resuscitation Burns and • Hold the injured area close to the stream Adult Defibrillation of water to avoid further pain. Child Resuscitation • If any clothing is wet with hot liquid, scalds hot fat or affected by a chemical splash, Baby Resuscitation remove it quickly and carefully. Special Resuscitation Background Avoid injury to yourself and Contact with any source of heat will cause a take special care of the victim’s CPR Chart burn or scald injury. A burn can result from face and eyes if a sweater or contact with a dry heat source such as hot T-shirt is removed over the head. Abdominal Injuries metal or electricity. A scald is caused by moist heat contact, such as a hot liquid or steam, • Remove any tight clothing, watch, rings Asthma and clothing over the area may retain the or jewellery from the injured area because heat and cause further injury. Prompt first of the risk of swelling. Allergic Reaction aid involves removing the source of heat and • Where possible, keep the injured part thorough cooling of the injured area. raised to reduce swelling. Bites and Stings • A superficial burn affects only the top layer of skin (previously called a 1st degree burn) • If cold water is not available, hydrogel Bleeding • A partial thickness burn damages deeper products may be used. However, cold water layers of skin (previously called a 2nd is always the best treatment for a burn. Burns and Scalds degree burn) Call 000 or mobile 112 for an Chest Injuries • A full thickness burn damages the skin  ambulance if the area of the burn and deeper tissues, such as muscle (previously or scald is larger than the palm Childbirth/Miscarriage called a 3rd degree burn). of the victim’s hand, because hospital treatment is needed. Choking Symptoms and signs Cold Illness • Severe pain (unless the damage is full 2 Treat victim for shock thickness and nerve endings are burnt) Convulsions/Seizures • If the victim is feeling faint or looking shocked • Red, peeling or blistered skin (or blackened if caused by electricity) and needing to lie down, place the injured Croup part (depending on the location of the burn) • Watery fluid weeping from the injured area in a bowl or bucket of cold water. If the water Diabetes • The victim is likely to be shocked, with pale, becomes warm, add some ice cubes to keep it cold and clammy skin, feeling faint and giddy, cool but avoid any contact with the burn area. Drug/Alcohol Overdose and complaining of nausea or vomiting • Swelling of the injured area may appear later Eye Injuries Fractures/Dislocations What to do — step by step Head Injuries 1 Cool the injured area Heart Conditions • Immediately cool the affected area for at least 20 minutes using cold running Heat Illness water from a tap or shower. Hyperventilation • Raise both legs on several pillows, a Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

rolled blanket or seat of a chair. Poisoning 3 Apply a sterile dressing Shock/Fainting • After cooling the injured area for up to 20 minutes, apply a sterile dressing. Spinal Injuries • Use a non-adherent dressing or a special Sprains/Strains/Bruises burn dressing that contains sterile ointment to soothe the pain and reduce Stroke the risk of infection. Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 42 Burns and scalds 2 of 4 Adult Resuscitation Burns that need Adult Defibrillation special care Child Resuscitation Baby Resuscitation Extensive burns or scalds Special Resuscitation If the injured area is greater than the size CPR Chart of the victim’s palm, medical assessment Do not break blisters or remove and treatment will be needed. Abdominal Injuries peeled skin. Asthma Do not try to remove any fabric What to do — step by step that is stuck to a burn. Allergic Reaction Do not use ice or ice water on 1 Cool the injury Bites and Stings the burn area as further burns • Cool the area only briefly because may result. prolonged cooling of a large area of the Bleeding Do not apply creams, ointments, body can cause hypothermia. Burns and Scalds or lotions to any burn injury because infection may occur and Cover the injury Chest Injuries complicate the injury. 2 • Use a sterile non-adherent dressing if Childbirth/Miscarriage Any substance applied to a burn available or, if the burnt area is more injury may have to be removed extensive, use a pillowcase or clean sheet Choking later in hospital. to cover the injury, but avoid any fluffy surface touching the wound. Cold Illness 4 Apply a light bandage Convulsions/Seizures • Keep the sterile dressing in place with Reassure the victim 3 Croup a loosely applied conforming cotton • Keep the shocked victim lying down with bandage. both legs raised. Diabetes Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions Call 000 or mobile 112 for an ambulance urgently. Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning • Check the bandage frequently to make Shock/Fainting sure it is not too tight if swelling occurs. Spinal Injuries Avoid using adhesive tape on the skin around the burn because this Sprains/Strains/Bruises may cause further tissue damage. Stroke Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 43 Burns and scalds 3 of 4 Adult Resuscitation Chemical burns Electrical or lightning burns Adult Defibrillation What to do — step by step Child Resuscitation If an electrical current passes through the body it is usual to find a small entry burn Baby Resuscitation 1 Quickly remove any but a large exit burn where the electricity contaminated clothing goes to “earth”. Special Resuscitation Avoid contact with any chemical CPR Chart and further injury to the victim. What to do — step by step Abdominal Injuries Make the area safe 2 Cool the injury 1 Asthma • Flood the burned area with copious • After checking that the area is safe and/ amounts of water for at least 20 minutes. or disconnecting a low voltage appliance Allergic Reaction Check MSDS if available. from the power source, check the victim for any burns. Bites and Stings 3 If a chemical solution has Bleeding splashed into the eye Cool the injury 2 Burns and Scalds • Hold the affected eyelids open to ensure • Use cold water on any visible injury. Always water washes thoroughly under the lids seek prompt medical advice however small Chest Injuries to remove any trapped chemical. the burn might appear to be because internal injuries may have occurred. Childbirth/Miscarriage Choking 3 If struck by lightning Cold Illness • If the victim is unconscious, be prepared to begin CPR — see Resuscitation. Convulsions/Seizures • If the victim does not need resuscitation, check for any burns, particularly on the Croup soles of the feet. Diabetes If an electrical storm is continuing with thunder and lightning, try Drug/Alcohol Overdose Call 000 or mobile 112 for an to find shelter for the victim and Eye Injuries ambulance urgently. yourself and ensure that you are not a high point for another bolt of Fractures/Dislocations Certain chemicals and products in the lightning. Avoid sheltering under a workplace require special treatment to tree unless there is no alternative, Head Injuries be available as follows: and if this is the only option, keep Heart Conditions Hydrofluoric acid burns: after flooding well away from the trunk. Ideally find protection in a vehicle or shed the affected area with running cool Heat Illness water, massage calcium gluconate gel where any further lightning strike will be carried to “earth” in the into the skin to reduce tissue damage. Hyperventilation DO NOT use your fingers but use structure. industrial gloves. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Cool the injury Phosphorus burns: remove any loose 4 Poisoning particles on the skin with tweezers. • Cool any burn until an ambulance arrives. DO NOT use your fingers. Keep the Shock/Fainting burned area wet to avoid ignition. 5 Seek medical assistance Spinal Injuries Bitumen burns: if a limb or finger is involved, keep flooding the area with Call 000 or mobile 112 for Sprains/Strains/Bruises water for at least 30 minutes. Split or an ambulance urgently. crack the material as it cools to avoid Assessment and treatment Stroke obstruction. in hospital is essential. Skills and Procedures

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© 201 © INDEX 4 FIRST AID EMERGENCY eHANDBOOK 5th ed 44 Burns and scalds 4 of 4 Adult Resuscitation Inhalation burns involving the Clothing on fire Adult Defibrillation mouth or throat Child Resuscitation What to do — step by step If the victim has been accidentally exposed to Baby Resuscitation fire or heated gases, damage may occur to the Extinguish the fire mouth and airway. There may be signs of burning 1 Special Resuscitation around the lips, nose, eyebrows or lashes. A dry • Smother the flames with a non-synthetic cough or hoarse voice is an early sign of airway coat or blanket and push the victim to CPR Chart damage and prompt medical care is essential. the ground to remove oxygen from the burning area. Abdominal Injuries What to do — step by step Asthma Be careful to check that the blanket Allergic Reaction Remove the victim to a safe area or coat does not contain synthetic 1 fibres which will melt onto the victim’s • If in a closed area, and if safe for the first skin and cause additional burns. Bites and Stings aider, it is vital to remove the victim to a place free of risk and preferably into fresh air. Bleeding • The rule is to STOP, DROP and ROLL the victim for safety before checking for Burns and Scalds 2 Cool the injury burns and cooling the injury — see Skills Chest Injuries • If smoke or toxic gases may have been and procedures, Fire. inhaled, including carbon monoxide from Childbirth/Miscarriage a vehicle exhaust, chlorine, ammonia or hydrochloric acid, give the victim sips of Choking cool water but do not give ice. • If there is any breathing difficulty, allow Cold Illness the victim to find the position of greatest comfort with the head and chest raised. Convulsions/Seizures Croup After an inhalation incident the victim may suffer from a severe lack of oxygen Diabetes due to internal damage to the throat, upper airway and lungs. It is important Drug/Alcohol Overdose to transfer the victim to hospital as soon as possible because there is a risk of Eye Injuries deterioration. Fractures/Dislocations  Call 000 or mobile 112 for an ambulance. Head Injuries Heart Conditions 3 Observe Airway, Breathing, Circulation Heat Illness • While waiting for ambulance assistance, Hyperventilation check the victim every few minutes for any change in condition. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

• Observe and note the breathing and Poisoning pulse rate which will both increase if the victim is deteriorating. Shock/Fainting • If there is any change in the level of consciousness, record this promptly. Spinal Injuries • If unconsciousness occurs, turn the victim Sprains/Strains/Bruises on the side and be ready to give CPR if necessary — see Resuscitation. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 45 1 of 2 Adult Resuscitation Adult Defibrillation What to do — step by step Chest injuries Child Resuscitation

Background 1 Assist the victim into a Baby Resuscitation comfortable position An injury to the chest wall may cause broken Special Resuscitation ribs and also may damage the two major • Assist the victim into the position of organs inside the chest, the lung or heart, greatest comfort, generally sitting or half- CPR Chart e.g. a knife wound over the left side of the sitting with support. This upright position chest wall. If an open wound is left in the Abdominal Injuries chest wall, air will enter and collapse the will assist breathing and make it less painful for each breath taken in. lung, causing severe breathing difficulty. Asthma The lung is kept inflated and against the • If the injury is to one side of the chest, inside of the chest wall by a negative the victim should lean towards the Allergic Reaction pressure, and once atmospheric air at injured side to avoid blood and other positive pressure enters through a wound, fluids flowing from the injured lung into Bites and Stings the lung collapses like a pricked balloon. the uninjured side. Bleeding Some vehicle accidents may cause severe injury • In an open space, kneel behind the victim to the chest including multiple rib fractures in which a “flail chest” develops. In this severe to provide support while assessing any Burns and Scalds condition the two sides of the chest wall move injuries. Loosen any tight clothing at neck separately and breathing becomes difficult, and waist to assist breathing. Chest Injuries leading to a lack of oxygen in circulation. The first aider may notice that one side of the chest Childbirth/Miscarriage moves inwards with each breath, whereas the 2 Check for a chest wound and uninjured side moves outwards in a normal close it Choking breathing pattern. • Check thoroughly, especially if there has Cold Illness been a knife or gun involved. Convulsions/Seizures Collapsed lung • If a wound is found, seal it closed immediately with your hand, preferably Croup with a bulky pad or piece of clothing as Wound a barrier. Diabetes Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions

Symptoms and signs Heat Illness • Pain in the chest or back, worse on coughing Hyperventilation • Breathing difficulty, especially breathing in • Coughing up of frothy, blood-stained fluid Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

• If a chest wound is present, air bubbling out Ltd. Poisoning Pty • Increasing shock — see Shock. • Blueness of the lips, inner mouth and finger tips Shock/Fainting • Deteriorating level of consciousness Call 000 or mobile 112 for an Spinal Injuries Administration • Abnormal chest movement ambulance urgently. Sprains/Strains/Bruises Tyrrells and Stroke Ltd

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© INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 46 Chest injuries 2 of 2 Adult Resuscitation Adult Defibrillation 3 Apply a sterile or clean dressing over the wound Child Resuscitation • As soon as possible seal it on three sides, Baby Resuscitation leaving the lower edge open to allow air under pressure to escape. Special Resuscitation CPR Chart Abdominal Injuries Asthma Allergic Reaction Bites and Stings Bleeding 4 Observe victim Burns and Scalds • While waiting for ambulance assistance, stay with the victim and check every few Chest Injuries minutes for any change in condition. • Observe and note the breathing and Childbirth/Miscarriage pulse rate, which will increase if internal bleeding is present. Choking • Check for and record any change in the Cold Illness victim’s level of consciousness. • If unconsciousness occurs, turn the victim Convulsions/Seizures When the lung has collapsed due to onto the injured side and check that the Croup the entry of atmospheric air at positive airway is clear and open. pressure, some air may be blown off Diabetes through the wound when the uninjured lung moves. It is important that the Drug/Alcohol Overdose open edge of the dressing is at the lower edge to act as a vent and to Eye Injuries avoid more air being sucked in. Fractures/Dislocations • The dressing can be covered with a piece of plastic wrap or aluminium foil to make Head Injuries it airtight. Heart Conditions • If a foreign body is still present in the wound, e.g. a knife, do not attempt to Heat Illness remove it because it will be creating an automatic airtight seal. Bulky dressings Hyperventilation may be packed around the foreign object to stabilise it — see Bleeding. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Ltd. Avoid pressure on a foreign • If the victim is not breathing normally, Poisoning Pty object in the wound. start CPR — see Resuscitation. Shock/Fainting • Do not give any food or fluids because • If no wound is present, support the chest an anaesthetic may be needed. If shock wall by binding the victim’s arm across Spinal Injuries Administration is severe or the victim is becoming the chest with a broad bandage. dehydrated and distressed, moisten the lips Sprains/Strains/Bruises Tyrrells with a damp cloth or give ice chips to suck. and Stroke Ltd

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© INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 47 1 of 4 Adult Resuscitation Adult Defibrillation Childbirth and Prepare for the baby’s arrival 2 Child Resuscitation • Prepare a clean sheet or towel for the baby’s miscarriage arrival and leave it in a warm place nearby. Baby Resuscitation • If the mother wants to push the baby out Special Resuscitation Background with each muscular contraction, ask her to Childbirth usually takes several hours. slow down the process by “panting like a CPR Chart Although in exceptional cases a baby arrives dog”. This may require you to pant with her suddenly before it is possible to move the to keep the mother from pushing down. Abdominal Injuries mother to hospital, it is rare for this to • If the baby is ready to be born, the mother happen with a mother’s first baby because Asthma the birth canal needs to undergo a great deal will be unable to pant and will push down of stretching and adaptation to allow the hard with each contraction until the baby’s Allergic Reaction baby’s head to move down from the womb. head is out of the birth canal. Bites and Stings • Help the mother to rest and relax between contractions. Symptoms and signs Bleeding • Check between the mother’s legs after • Lower abdominal cramp-like pains at regular Burns and Scalds intervals each contraction to see whether the • An urge to push down when the baby is baby’s head is visible. If it can be seen, Chest Injuries ready to be born be ready to assist with the baby’s birth. • A feeling of excitement mixed with anxiety Childbirth/Miscarriage 3 Assist with delivery of the baby Choking • As the baby’s head moves out, be ready Cold Illness What to do — step by step to support the head and check that the umbilical cord is not around the baby’s Convulsions/Seizures Assist the mother into a suitable neck. If a loop of cord is seen or felt at 1 the neck, try to ease it over the baby’s Croup position head for safety. The baby’s head will then • Assist her to lie down on a bed, or the move forwards with each contraction Diabetes floor, if delivery seems to be imminent. until it is fully delivered. Drug/Alcohol Overdose • Place a piece of plastic covered by old • Once the head is free of the birth canal, sheets or towels under the mother to the baby’s head and shoulders will be Eye Injuries protect the bed or floor. seen rotating sideways to permit delivery • Reassure the mother that help is coming of the baby’s trunk and limbs. There is Fractures/Dislocations and that you will stay with her. no need to assist in this process but it is important to wipe clean the baby’s mouth Head Injuries Call 000 or mobile 112 for an and nose so that the baby is safe to take  Heart Conditions ambulance. its first breath as soon as the body is born. • With the next contraction, the baby’s Heat Illness shoulders, trunk and limbs will slip out of the birth canal and the baby should take Hyperventilation its first breath and then cry a little. The Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED baby’s colour will then change from

a dark blue to a bright pink as the lungs Poisoning fill with fresh air and oxygen. Shock/Fainting • Dry the baby in a warm towel or sheet. Place the baby on the mother's abdomen Spinal Injuries for extra warmth. Place a warm blanket over the mother and baby. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 48 Childbirth and miscarriage 2 of 4 Adult Resuscitation • Check that the mouth and nose are still Adult Defibrillation clear and that the baby is breathing quietly. Child Resuscitation • The umbilical cord and afterbirth will still be inside the mother and the first Baby Resuscitation aider should avoid pulling on the cord at any stage. Special Resuscitation • Leave the baby attached to the umbilical CPR Chart cord until the large blood vessels stop pulsating. At this point the baby is Abdominal Injuries breathing and circulating oxygen-rich blood independently of the mother. Asthma • If the ambulance is due, leave the cord Allergic Reaction attached to the baby until the ambulance crew arrive. Bites and Stings • If there is likely to be a delay in the arrival Bleeding of the ambulance, prepare to cut the cord. Cut three pieces of clean string into Burns and Scalds lengths of approximately 20cm each. Tie the first piece approximately 10cm from Chest Injuries the baby’s navel, and the second 15cm Childbirth/Miscarriage away from the navel. Tie a third piece 20cm away from the baby's navel. Choking 4 Assist with delivery of the • Use sharp scissors to cut between the afterbirth Cold Illness second and third ties and sever the cord, leaving two ties in place. • Allow the mother to nurse or breast-feed Convulsions/Seizures her baby to encourage the womb to contract and deliver the afterbirth. Croup • If the afterbirth is delivered, place it in Diabetes a covered container for the doctor or midwife to check later. Sometimes small Drug/Alcohol Overdose pieces of afterbirth become dislodged and may be retained in the womb and Eye Injuries cause a severe infection. Fractures/Dislocations Head Injuries Heart Conditions Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning

• Keep the mother lying down at rest until Shock/Fainting the ambulance arrives. Spinal Injuries • Give the mother fluids to drink to replace those lost during the birth process. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 49 Childbirth and miscarriage 3 of 4 Adult Resuscitation

Childbirth complications Adult Defibrillation What to do — step by step Child Resuscitation Background Baby Resuscitation There are a number of problems that 1 Call urgently for medical can occur during childbirth and very little assistance Special Resuscitation that a first aider can do except stay with the mother and keep her calm until an Call 000 or mobile 112 for an CPR Chart ambulance arrives. ambulance, or contact a local Abdominal Injuries Sometimes the baby is not positioned doctor for help. correctly for a simple delivery and the baby’s • Keep the mother at rest. Reassure Asthma hand or foot, face or buttocks may appear her but encourage her to try to in the birth canal before the head is ready to stop pushing with each contraction. Allergic Reaction be born. This can cause serious injury to both Ask the mother to pant hard with baby and mother and the first aider needs to Bites and Stings reassure the mother until trained help arrives. each contraction to slow the baby’s progress down the birth canal. Sometimes the placenta starts to pull away Bleeding from the lining of the womb before the baby • If the mother is in severe pain or has is born, causing severe bleeding from the lost a quantity of blood, manage her Burns and Scalds mother, and complications for the baby. for shock — see Shock. Chest Injuries If the baby becomes distressed during the • If the mother is still lying on her back, birth process, the heartbeat will increase. place some padding under her right Childbirth/Miscarriage This is a serious emergency and requires hip and buttock to move the baby urgent medical care. off her deep veins and assist with the Choking return of blood to her heart. Cold Illness • If the mother loses consciousness, Symptoms and signs place her in the recovery position on Convulsions/Seizures • Severe lower abdominal pain caused by her left side and be ready to begin obstruction of labour CPR — see, Resuscitation during Croup • The appearance of a baby’s foot, hand, face the last weeks of pregnancy. or buttocks from the birth canal, instead of Diabetes the top of the head If resuscitation is required in Drug/Alcohol Overdose • Bleeding from the birth canal late pregnancy it is vital to keep • Greenish/black staining of the fluid draining the mother tilted to the left to Eye Injuries from the birth canal keep the weight of the baby off Fractures/Dislocations • No obvious progress despite strong her deep veins. contractions. Head Injuries Heart Conditions Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 4 FIRST AID EMERGENCY eHANDBOOK 5th ed 50 Childbirth and miscarriage 4 of 4 Adult Resuscitation Miscarriage 2 Observe the victim closely Adult Defibrillation • Check the victim’s breathing and pulse Child Resuscitation Background rates every few minutes. Note any If a mother loses her baby before the 20th increase in the rates because this may Baby Resuscitation week of her pregnancy, it is known as a indicate severe bleeding. miscarriage. This can be a serious medical Special Resuscitation emergency due to the degree of shock and sudden blood loss, but also causes an CPR Chart emotional stress for the mother. Abdominal Injuries Symptoms and signs Asthma • Heavy vaginal bleeding in a pregnant woman Allergic Reaction • Severe cramp-like pains in the lower abdomen Bites and Stings • Pale, cold and clammy skin due to shock — see Shock. Bleeding • Rapid and weak pulse rate Burns and Scalds • If the breathing and pulse rates increase, Chest Injuries What to do — step by step manage the victim for shock — see Shock. Childbirth/Miscarriage 1 Assist the victim to rest Stay with the victim until the Choking • Assist the victim to lie down at complete 3 rest in the position of greatest comfort. ambulance arrives Cold Illness • Moisten the victim’s lips if they are • Place a pillow or rolled towel under the Convulsions/Seizures knees to ease abdominal pains and spasm. dry, but avoid giving any food or fluids because an anaesthetic is likely to be Croup needed on arrival in hospital. • Reassure the victim until the ambulance Diabetes arrives. Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning • Check the bleeding every few minutes Shock/Fainting and note whether clots are present. Spinal Injuries Call 000 or mobile 112 for an ambulance as soon as possible. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 51 1 of 2 Adult Resuscitation Choking Partial (mild) airway obstruction Adult Defibrillation Child Resuscitation Background What to do — step by step Choking occurs when a person is unable to Never use back blows on a person who is Baby Resuscitation breathe due to obstruction in the throat or able to cough effectively or breathe. windpipe (trachea). This airway obstruction Special Resuscitation can be caused by an inhaled foreign body, trauma or internal swelling associated with 1 Reassure and encourage the victim CPR Chart an anaphylactic reaction. The onset is likely • Stay with the victim until full recovery has Abdominal Injuries to be sudden when caused by an inhaled occurred. foreign body, but more gradual in onset when due to internal swelling. • Encourage the victim to cough and expel Asthma the foreign body. Partial (mild) airway obstruction: the victim Allergic Reaction will be able to breathe and cough, although If the obstruction is not relieved, call there may be a “crowing noise” (stridor) as Bites and Stings air passes through a narrowed space. Usually  000 or mobile 112 for an ambulance. the victim can clear a small foreign body by Bleeding coughing and, although the breathing may be noisy, air can still enter and leave the lungs. Burns and Scalds At this stage it is important to avoid giving backblows which may cause a foreign body Chest Injuries to move and become a total obstruction. Total (severe) airway obstruction: the Childbirth/Miscarriage airway is completely blocked and no air can move up or down the windpipe into the Choking lungs. The victim cannot cough effectively and may die of a total obstruction unless Cold Illness prompt first aid is given. Convulsions/Seizures Croup

Normal passage of food Diabetes

Food inhaled down Drug/Alcohol Overdose windpipe Total (severe) airway obstruction Eye Injuries

What to do — step by step Fractures/Dislocations Symptoms and signs Head Injuries Partial (mild) airway obstruction: Call 000 or mobile 112 for an • Breathing laboured, gasping or noisy  ambulance. Heart Conditions • Some air escaping from the mouth Heat Illness • Victim coughing or making a “crowing noise” 1 If the victim is conscious, give up • Extreme anxiety or agitation to five back blows Hyperventilation Total (severe) airway obstruction: • With an adult or child standing or sitting Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED • Victim unable to effectively cough, breathe and using the heel of one hand, give up or speak, with no air movement to five back blows between the victim’s Poisoning • Victim making obvious efforts to breath with shoulder blades. Shock/Fainting in-drawing of spaces between the ribs and • Place a baby face down across your lap above the collar bones for the back blows. Spinal Injuries • Victim’s face is greyish in colour with blue (cyanosed) lips due to lack of oxygen The back blows are given separately Sprains/Strains/Bruises • Victim clutching the throat with both hands with a check after each one to see if (universal choking sign) the obstruction has been relieved. Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 52 Choking 2 of 2 Adult Resuscitation Adult Defibrillation Child Resuscitation Baby Resuscitation Special Resuscitation CPR Chart Abdominal Injuries Asthma Allergic Reaction Bites and Stings Bleeding Burns and Scalds Chest Injuries 3 If the obstruction has not been Childbirth/Miscarriage relieved, continue by alternating back blows and chest thrusts until Choking the ambulance arrives. Cold Illness Convulsions/Seizures 2 If unsuccessful, give up to five chest Unconscious thrusts. Croup • With an adult or child standing or sitting What to do — step by step Diabetes place one hand over the lower half of the breastbone (sternum) as for CPR, and the Call 000 or mobile 112 for an Drug/Alcohol Overdose other hand over the spine at the same  ambulance. level. Give up to five sharp chest thrusts Eye Injuries at a slower rate than for CPR. 1 If the victim is unconscious Fractures/Dislocations • Quickly check the mouth and use your Head Injuries fingers to remove any visible solid obstruction. Heart Conditions 2 Begin CPR Heat Illness • If there is no normal breathing give 30 Hyperventilation compressions at the rate of approximately Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED 100 compressions per minute, alternating

with two rescue breaths. Poisoning • Place a baby face upwards across your lap There may be some resistance to Shock/Fainting and give up to five sharp chest thrusts as inflations at first until the object has for CPR, but at a slower rate. been dislodged. Spinal Injuries

The chest thrusts are given separately • Continue CPR until the ambulance arrives Sprains/Strains/Bruises with a check after each one to see if — see Resuscitation. the obstruction has been relieved. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 53 1 of 2 Adult Resuscitation Rewarm the victim 2 Adult Defibrillation Cold illness • Help the victim to rest lying down in a Hypothermia sleeping bag if available. Child Resuscitation • Ensure that there is protection Baby Resuscitation underneath the body to avoid losing Background more body heat into the ground. Special Resuscitation Hypothermia is a serious medical condition • Cover the victim with a blanket, dry that occurs following exposure to extreme clothing or an aluminium foil rescue CPR Chart cold. Exposure to cold conditions can be blanket, to maintain body heat. made more serious if the victim’s clothes Abdominal Injuries are wet, especially in a cold wind. In serious hypothermia, as internal organs cool, the Asthma victim’s level of consciousness will deteriorate and, unless prompt medical care is available, Allergic Reaction death may occur. Accidental hypothermia also can affect Bites and Stings an elderly or very young person wearing inadequate clothing in cold conditions or Bleeding living in an unheated room, especially when malnutrition is present. Burns and Scalds Frostbite occurs when one part of the body is exposed to extreme cold and usually Chest Injuries involves an extremity. Most commonly this Childbirth/Miscarriage affects the fingers or toes, but frostbite • Give a warm drink. may involve the nose or ears if the head is uncovered in freezing conditions. Avoid hot drinks or alcohol because Choking this will divert blood to the stomach and away from the cold body parts. Cold Illness Symptoms and signs Do not use direct heat or massage Convulsions/Seizures • Shivering in the early stages of hypothermia to rewarm the victim, e.g. a camp • Apathy and confusion fire, blow heater or hot packs, Croup • Poor coordination because these will take heat to Diabetes • Exhaustion and disorientation the skin surface and away from • Slowing pulse rate, often irregular beats the cold body organs. Drug/Alcohol Overdose • Collapse and unconsciousness in late stages 3 Obtain medical help Eye Injuries What to do — step by step Use a mobile phone to call for Fractures/Dislocations  an ambulance on 112. Otherwise Head Injuries Shelter the victim send someone to call for help at 1 the nearest township or main road. Heart Conditions • Either find a solid shelter nearby or improvise a windbreak and rain protection. • Stay with the victim and note the level of consciousness, breathing and pulse rate at Heat Illness • If the shelter is adequate, assist the victim 10 to 15 minute intervals until help arrives. to remove all wet and cold clothing and Hyperventilation replace with dry articles. • If the victim becomes unconscious, place in the recovery position and be prepared to Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED • If no shelter is available, wrap warm begin CPR if necessary — see Resuscitation. clothing or a blanket around the victim Poisoning over the wet clothes. If cardiopulmonary resuscitation (CPR) is necessary, continue for as Shock/Fainting Do not remove cold, wet clothing long as possible or until help arrives, in exposed conditions because because recovery may be very slow Spinal Injuries this may cause a further drop in if hypothermia is present. A full body temperature. recovery is unlikely until the body Sprains/Strains/Bruises temperature rises, but the victim Stroke may recover later in hospital. Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 54 Cold illness 2 of 2 Adult Resuscitation Frostbite 3 Protect the affected area Adult Defibrillation • Apply sterile, soft dressings between the affected fingers or toes. Child Resuscitation Symptoms and signs • White and waxy skin Baby Resuscitation • Tingling at first, then loss of sensation in the Special Resuscitation affected part • Altered skin colour from pink initially, to blue, CPR Chart then yellow or white later • Affected skin surface is colder than the rest Abdominal Injuries of the area Asthma

What to do — step by step Allergic Reaction Bites and Stings Protect the victim 1 Bleeding • Avoid further exposure to the cold source. • Then apply soft padding and a protective • Remove any item that may be affected bandage to the whole area. Burns and Scalds by later swelling, e.g. wristwatch, ring or other jewellery. Chest Injuries Childbirth/Miscarriage Gently rewarm the part 2 Choking • Use body heat to rewarm, e.g. ask the victim to place the fingers in the opposite Cold Illness armpit, or cover the nose, chin or ears with gloved hands. Convulsions/Seizures • If warm water is available, place the Croup affected fingers or toes in warm water until the victim feels tingling. Diabetes Drug/Alcohol Overdose • For other body parts, protect the tissues with soft padding. Eye Injuries • Raise the affected part to reduce pain Fractures/Dislocations and swelling. If the fingers are affected, apply an elevation sling — see Skills and Head Injuries procedures, Slings. Heart Conditions 4 Obtain medical advice Heat Illness Contact the local doctor or Hyperventilation  attend the nearest hospital Accident and Emergency Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Department for advice and treatment. Poisoning • Pat dry the fingers or toes using gentle movements. Shock/Fainting Do not use direct heat or massage Spinal Injuries to rewarm the victim, e.g. a blow heater or hot packs, because these will Sprains/Strains/Bruises take heat to the skin surface and cause severe pain and possible tissue damage. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 55 1 of 2 Adult Resuscitation What to do — step by step Convulsions Adult Defibrillation 1 Protect the victim from injury Child Resuscitation and seizures • Check the immediate area for hazards Baby Resuscitation and remove them if possible. Move furniture away from the person but take Special Resuscitation Background special care with electrical appliances or A convulsion occurs only in early childhood cooking utensils to avoid a burn or scald. CPR Chart when a child under the age of six years has a • If the victim is close to a wall or hard high fever caused by a severe infection. furniture, pad the area with clothing or a Abdominal Injuries A seizure can occur at any age and is due pillow to avoid further injury. Asthma to abnormal electrical activity in the brain resulting in uncontrollable muscular activity Allergic Reaction and loss of consciousness. There are many types of seizure with some being relatively Bites and Stings mild and others severe and prolonged. The term “fit” is no longer recommended for Bleeding use when referring to an epileptic seizure, because the condition is a recognised illness. Burns and Scalds One mild form of epileptic seizure is known as petit mal or absence seizure: the victim Chest Injuries stops suddenly and stares into space without any awareness of the surrounding Childbirth/Miscarriage environment or dangers. After a few seconds the victim suddenly recovers and continues Choking the interrupted activity as if nothing unusual had occurred. A full-scale epileptic seizure Cold Illness involves violent jerking of the limbs, facial Do not move or try to restrain twitching and foaming at the mouth due to the victim’s movements because Convulsions/Seizures saliva being blown through clenched teeth. this may result in a broken bone The seizure may last for one or two minutes or soft tissue injury. Do not try to Croup and the victim may need several hours in pad between the victim’s teeth which to recover. because this may damage the Diabetes If a person with any form of epilepsy wants tissues in the mouth. to take part in swimming or other water Drug/Alcohol Overdose activities, it is vital to be accompanied by a person who is competent to recognise the 2 Manage the seizure or Eye Injuries early warning signs of a seizure and to carry convulsion out a prompt rescue if necessary. Generally Fractures/Dislocations it is safe for the victim to remain in water • Stay with the victim until the seizure during the seizure, provided that someone is ends. Head Injuries supporting the head and shoulders above the • If in a public place, keep bystanders clear water. Removing a person from water during Heart Conditions and reassure them that the seizure will a seizure is dangerous for both the victim and rescuer, but easier and safer to perform end soon. Heat Illness once the convulsive stage has ended. • Loosen any tight clothing at the victim’s neck and waist, but be aware of the risks Hyperventilation of personal injury from flailing limbs. Symptoms and signs Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED • Jerking or twitching of the face and limbs Avoid giving anything to eat Poisoning • Foaming at the mouth or drink until the victim is fully • Loss of consciousness conscious. Shock/Fainting • Loss of control of bladder and/or bowel • Wait for the seizure to finish before Spinal Injuries • Blue/purple skin colour and blue lips attempting any other care of the victim. • Flushed and dry skin in a child having a Sprains/Strains/Bruises feverish convulsion Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 56 Convulsions and seizures 2 of 2 Adult Resuscitation After the seizure 3 Special care for a feverish Adult Defibrillation • As soon as the jerking ends, quickly roll convulsion in a child the unconscious victim onto the side and Child Resuscitation clear and open the airway. What to do — step by step Baby Resuscitation 1 Ensure the child’s safety from Special Resuscitation any hazards CPR Chart 2 Remove all clothing down to a Abdominal Injuries nappy or pants to allow the skin to cool naturally Asthma Allergic Reaction • Cover the victim lightly with a coat or Wait until the convulsion ends blanket in case there is incontinence due 3 Bites and Stings to loss of bladder or bowel control. before rolling the child or baby • Check that normal breathing has onto the side Bleeding resumed. • Allow the victim to sleep until fully Burns and Scalds recovered, but check for a response every Chest Injuries few minutes. If the victim does not respond, Childbirth/Miscarriage call 000 or mobile 112 for an ambulance urgently. Choking Cold Illness 4 After care Convulsions/Seizures • Check for a Medic Alert pendant or bracelet stating that the wearer suffers Croup from epilepsy. Diabetes • Check for any injuries and treat a bleeding wound promptly — see 4 Clear and open the airway and Drug/Alcohol Overdose Bleeding. check that normal breathing has • Reassure the victim as full consciousness returned Eye Injuries is restored. Contact the local doctor for advice Fractures/Dislocations • Advise the victim not to drive. Try to as soon as possible and before the arrange for someone to be with the temperature goes up again. Head Injuries victim until safely home. Heart Conditions • Advise the victim to contact the doctor • You may be advised to give some to report the seizure and check that any Heat Illness prescribed medication is adequate. medication to control the temperature and avoid another convulsion. • If the victim is known to have epilepsy, Hyperventilation there is no need for medical aid or an Avoid giving anything to drink ambulance unless the seizure lasted more until the child is fully conscious. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED than five minutes or a second seizure Do not cool the child by artificial Poisoning followed. If it is the first known seizure, means such as fanning or a cold medical advice is vital to avoid any future bath because this can cause Shock/Fainting complications. complications later. • If the victim is a child, is known to have Spinal Injuries diabetes or is obviously pregnant, an Allow the temperature to fall ambulance should be called promptly by natural means and obtain Sprains/Strains/Bruises because of the risk of complications. medical advice as soon as possible to diagnose the problem and Stroke prescribe treatment. Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 57 1 of 1 Adult Resuscitation What to do — step by step Adult Defibrillation Croup Child Resuscitation 1 Relieve the breathing difficulty Baby Resuscitation • Reassure and keep the child calm. Ensure Background that warm clothing is being worn. Special Resuscitation Croup is usually the result of a viral infection. • Close all windows and doors to reduce It affects babies and young children and draughts. CPR Chart rarely occurs after the age of five years. • If the child is feverish with a temperature Abdominal Injuries Croup is a form of obstructive breathing in of more than 38ºC, or complains of a which the larynx (voice box) is narrowed by sore throat, give one dose of paracetamol. Asthma swelling as a result of an upper respiratory Strictly follow the dosage instructions on tract infection. In severe cases the airway the bottle and, if the child does not Allergic Reaction may close over totally so that medical advice improve, check with your doctor before is important at the first signs of the illness. giving a further dose. Bites and Stings It often follows an upper respiratory tract infection such as a heavy cold or tonsillitis. Bleeding Another severe form of croup is epiglottitis Burns and Scalds (inflammation of the epiglottis just above the larynx), which is generally caused by a Chest Injuries bacterial infection. This condition may also lead to total airway obstruction and generally Childbirth/Miscarriage requires a stay in hospital under close supervision until the child starts to recover. Choking Croup is usually worse at night and generally Cold Illness lasts three to four days. On some days the child may seem to be fully recovered, only Convulsions/Seizures to deteriorate again in the evening. Croup Diabetes Symptoms and signs Drug/Alcohol Overdose • Noisy breathing with a high-pitched sound, (called stridor), especially when breathing in Eye Injuries • A harsh, barking cough followed by a period of breathlessness 2 Obtain medical advice and care Fractures/Dislocations • Bluish colouration of the lips, ear lobes and • Even though the child may seem to be Head Injuries fingertips better, contact the local doctor for advice • Visible breathing effort with drawing-in of on further treatment. Heart Conditions the ribs when breathing in • Ensure that the child stays at rest in a Heat Illness • Use of the muscles in the neck to assist with warm room. breathing Hyperventilation • Anxiety and distress • Give frequent drinks of clear fluids, e.g. cordials, to avoid dehydration from the Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED effort of breathing and having a high

temperature. Poisoning If the child does not improve, Shock/Fainting  obtain prompt medical advice or call 000 or mobile 112 for an Spinal Injuries ambulance. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 58 1 of 1 Adult Resuscitation Adult Defibrillation Diabetes What to do — step by step Child Resuscitation Background 1 Give the victim some sugar Baby Resuscitation Diabetes is a medical condition in which • If the victim is still fully conscious and there is a failure of insulin production in the able to swallow, give a sweetened drink, Special Resuscitation pancreas. The result is a failure to process chocolate or glucose sweets to suck. carbohydrates, fats and proteins correctly CPR Chart and the victim loses weight, becomes very • If the victim is able to cooperate and thirsty and passes large quantities of urine. swallow safely, an improvement usually Abdominal Injuries The victim of diabetes is usually treated with occurs within minutes. a modified diet or daily insulin injections. • When the victim is more alert, offer a Asthma However, if the correct diet is not followed, more substantial carbohydrate meal of a Allergic Reaction or if a severe infection occurs, this can lead sandwich or several sweet biscuits. to an insulin coma from too little sugar in circulation (hypoglycaemia). Unless prompt Remember that because the Bites and Stings first aid with sugar plus follow-up medical symptoms and signs of too much care is available, death may occur. sugar and too little sugar are very Bleeding The reverse condition of hyperglycaemia similar, it is always best to assume Burns and Scalds occurs when the victim lapses into a diabetic that a low blood sugar is present coma from too much sugar in the body. (hypoglycaemia), as this is the more Chest Injuries However, this condition is not as common serious condition. If there is already as hypoglycaemia and has a very slow onset. Because it is a less serious condition, sugar is too much sugar in the body, a sweet Childbirth/Miscarriage still given because of the risk of the condition drink and sandwich will make very being hypoglycaemia which could result in little difference to the victim. Choking collapse and death before medical care is Give frequent reassurance during available. Cold Illness recovery because the victim may be confused until fully recovered. Convulsions/Seizures Symptoms and signs Croup Obtain medical advice • Extreme tiredness and loss of concentration 2 Diabetes • Severe thirst • If the victim has improved with the intake • Abdominal pain of carbohydrate, medical advice is still Drug/Alcohol Overdose necessary because a further deterioration • Nausea or vomiting may occur at any time. You may be advised Eye Injuries • Dizziness and loss of coordination to take the victim to a local doctor, or to • Erratic or argumentative behaviour a diabetic clinic in a hospital, depending Fractures/Dislocations • Rapid loss of consciousness if not treated on circumstances. promptly Head Injuries If the victim does not improve after • Persistent headache swallowing the sweet food or drink, Heart Conditions • Flushed or pale face or if further deterioration occurs • Sunken eyes and parched lips and swallowing becomes difficult or Heat Illness impossible, call 000 or mobile 112 for an ambulance. Hyperventilation • While waiting for the ambulance to Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED arrive, check and record the level of consciousness and note the breathing Poisoning and pulse rates. Shock/Fainting Do not try to give the victim a dose of insulin because this can be Spinal Injuries dangerous unless a medical assessment has been carried out and Sprains/Strains/Bruises the victim’s blood sugar level tested. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 59 1 of 2 Adult Resuscitation What to do — step by step Adult Defibrillation Drug and alcohol Avoid contact with any of the victim’s body fluids including Child Resuscitation blood, saliva, vomit or urine. Look overdose around carefully for a syringe, Baby Resuscitation needle or other sharp object that Background might penetrate the skin. Special Resuscitation Almost any drug taken in excess can cause a person to suffer the effects of an overdose. If there is any contact with the CPR Chart Some prescribed medicines and recreational victim’s body fluids during the first drugs taken in excess or without medical aid treatment, wash all contaminated Abdominal Injuries supervision can prove fatal unless prompt skin surfaces thoroughly with soap emergency care is available. and water. Dry the skin well and Asthma The effects of any drug will vary depending on contact your doctor for further the nature of the substance, the age, weight advice about protection from any Allergic Reaction and general health of the victim, and whether infectious diseases. any alcohol was consumed at the same time. Bites and Stings Many young people are exposed to the risks Bleeding of taking a “recreational drug” at a party or 1 Assess the victim entertainment venue, often without knowing • Check the level of consciousness. If the Burns and Scalds the nature of the substance concerned. person is not fully conscious and alert, try Sometimes a cocktail of drugs may be taken Chest Injuries in the hope of enjoying a “high”, but this to turn the victim onto the side into the recovery position — see Resuscitation. can prove to be a fatal step and seriously Childbirth/Miscarriage complicates the medical treatment required. Such recreational drugs include a range of Choking stimulants, including ‘ecstasy’, amphetamines (‘speed’), and cocaine etc. Depressant drugs Cold Illness may also be abused and include various narcotics and barbiturates. Hallucinogenic Convulsions/Seizures drugs that may be taken include marijuana, “magic mushrooms” or LSD. The first aider Croup will be unable to give any specific treatment for the victim of drug abuse and can only give Diabetes care following the normal priorities of basic life support — see the Basic Life Support Drug/Alcohol Overdose Flow Chart. Alcohol taken in excess, as in “binge Call 000 or mobile 112 for an Eye Injuries drinking”, can have a serious effect on the ambulance. body. In the early stages the victim may be Fractures/Dislocations unaware of hazards, with loss of coordination, • Be ready for an unexpected move by the and is at risk of injury. Later the victim is victim and avoid putting yourself and others Head Injuries likely to become unconscious and needs close at risk of a punch or blow by staying too close. supervision and airway care to avoid airway Heart Conditions obstruction and possible death. 2 Reassure the victim Heat Illness Symptoms and signs • Talk to the victim in a quiet and reassuring manner. Hyperventilation • Drowsiness, loss of coordination and collapse • Rapid and weak pulse Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

• Confusion or hallucinations Poisoning • Altered breathing pattern or breathing difficulty • Mood changes including excitability, Shock/Fainting aggression or depression • Pale, cold and clammy skin Spinal Injuries • Nausea or vomiting Sprains/Strains/Bruises • Seizures • Abdominal pain Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 60 Drug and alcohol overdose 2 of 2 Adult Resuscitation 3 Identify the drug taken • Drop the syringe and needle into the chosen container and seal the top Adult Defibrillation • Ask what the victim has taken and securely. Mark the outside as ‘Hazardous whether it was swallowed, inhaled or Waste’ and arrange disposal through your Child Resuscitation injected — see Poisoning. local doctor, hospital or council. Baby Resuscitation • Look for evidence that might assist the hospital staff with treatment and keep If you injure yourself with a Special Resuscitation any container, syringe or needle and any 2 vomit to aid analysis and identification. needle CPR Chart • Wash the injured area thoroughly with • Maintain body heat with a coat or Abdominal Injuries blanket to avoid heat loss. In cold weather soap and warm water. in the outdoors environment, place fabric • Apply an antiseptic in accordance with Asthma under the victim if possible to reduce the directions on the label. heat loss from lying on a cold surface. • When the area is dry, apply a sterile Allergic Reaction adhesive dressing. Some drugs create serious Bites and Stings overheating of the body and if • Obtain further advice from your local this is noticed, remove unnecessary doctor as soon as possible, and within Bleeding clothing to allow air to reach the 24 hours of the injury. skin surface to assist with cooling. Burns and Scalds Chest Injuries 4 Give emergency care Accidental overdose of drugs Childbirth/Miscarriage • Keep talking to the victim to monitor For first aid management of an accidental the level of consciousness and note any overdose of medicines or drugs — see Choking changes, especially any deterioration Ingested poisons. • Frequently check that the airway is clear Many medicines have lifesaving properties Cold Illness and note the breathing and pulse rates. but, if taken in excess, some can cause serious illness or even death. If a small child Convulsions/Seizures takes medicines that have been prescribed for an adult, even a small dose may lead to Croup Needle stick injury unconsciousness and death. All medicines should be kept in a safe area Diabetes The risk of catching any disease from contact out of the reach of children. Wherever with a discarded syringe needle is extremely possible medicines should be kept in a locked Drug/Alcohol Overdose low; however, it is advisable to take care cupboard with the exception of those that whenever you pick up a used needle. need to be kept in a refrigerator. In this Eye Injuries situation it is possible for a child to reach the medication and it is wise to request the Fractures/Dislocations pharmacist to provide a childproof container if possible. Head Injuries If a medicine is taken only on an occasional Heart Conditions basis, be sure to check the expiry date and obtain a new prescription before the Heat Illness medication is out of date. If you find a syringe with a needle Clean out all medicines at least once a year Hyperventilation 1 and return unused or expired doses to the • Obtain a strong plastic or glass screw top pharmacist for safe disposal or for use in Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED container, such as one used for fruit juice overseas aid. Poisoning or jams. Take the container to the syringe If a person is taking a large number of and needle. medicines at different times of the day it may Shock/Fainting • Pick up the syringe by the barrel, holding be advisable to use a Dosett in which doses it at the end furthest away from the for the coming week are pre-sorted according Spinal Injuries needle. If the needle and syringe have to the times of day required. been separated, do not attempt to Sprains/Strains/Bruises replace the needle on the syringe, or replace any cap on the needle. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 61 1 of 2 Adult Resuscitation Adult Defibrillation Major eye conditions Eye injuries Child Resuscitation What to do — step by step Baby Resuscitation Background The eye is a delicate structure that is easily 1 Rest and reassure the victim Special Resuscitation damaged by a small foreign body. If a foreign • For a serious eye injury, help the victim to CPR Chart body scratches or scars the eye surface, the rest in the position of greatest comfort victim may lose some or all vision in the with the injured eye closed. injured eye. Abdominal Injuries A heavy blow may injure soft issues and Asthma bone around the eye. This can result in pressure on the eyeball and cause blurred or Allergic Reaction double vision, or even blindness. In a workplace where welding is undertaken Bites and Stings a painful flash injury may occur unless personal protective equipment is used Bleeding correctly. A chemical splash in the eye can cause Burns and Scalds permanent loss of vision and needs prompt first aid and medical care. Chest Injuries

• Keep the head slightly raised above the Childbirth/Miscarriage level of the shoulders to reduce any Choking Cornea internal bleeding. • Advise the victim to avoid all movement Cold Illness Optic nerve Lens of the head to prevent further eye damage. Convulsions/Seizures Iris • Reassure the victim that expert help will Croup Retina be obtained and that the injury may not be as serious as it appears to be. Diabetes

Extraocular Protect the injured eye Drug/Alcohol Overdose muscles 2 • Cover the injured eye with a sterile eye Eye Injuries pad or sterile wound dressing. If there is a large foreign body lodged in the eye, Fractures/Dislocations do not attempt to remove it, but pad Symptoms and signs around the eye socket to avoid pressure Head Injuries • Pain in, or behind, the eye when the dressing is applied. Heart Conditions • Spasm of the eyelids • A continuous flow of tears from one eye It is no longer recommended to Heat Illness • Reduced or altered vision, or even loss of cover both eyes. sight Hyperventilation • Blood visible in the eye, or bleeding around • Fix the eye pad or dressing in place Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED the eye with several strips of adhesive tape or with several turns of a loosely applied Poisoning conforming cotton bandage around the head. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 62 Eye injuries 2 of 2 Adult Resuscitation Adult Defibrillation Child Resuscitation Baby Resuscitation Special Resuscitation CPR Chart Abdominal Injuries Asthma • Advise the victim to keep the uninjured If the object is not removed with eye closed to reduce the risk of one attempt, do not continue Allergic Reaction movement of the injured eye. because of the risk of scratching the eye surface and causing scarring. Bites and Stings 3 Arrange for medical care If the foreign object cannot be Bleeding Once the eye is covered, call 000 seen clearly or is over the coloured Burns and Scalds or mobile 112 for an ambulance part of the eye, do not try to remove it but manage the victim because medical care in hospital Chest Injuries is needed. as for a serious eye injury. • Continue to give reassurance and Childbirth/Miscarriage If unsuccessful, the foreign body encouragement to the victim. 2 Choking • While waiting for the ambulance to may be removed by gentle arrive, check the victim for any other flushing of the affected eye Cold Illness injuries, particularly if a blow or fall was involved. Convulsions/Seizures • Check the level of consciousness Croup and ensure that the airway is clear. Remember that an injury around the eye Diabetes may be associated with concussion or other head injury — see Head injuries. Drug/Alcohol Overdose Eye Injuries Minor eye conditions Fractures/Dislocations Head Injuries What to do — step by step Heart Conditions 1 Removal of a foreign body Heat Illness • Check whether the foreign material is • Use a clean jug filled with water and Hyperventilation visible on the white part of the eye. pour a stream of fluid across the injured • Ask the victim to blink several times to try eye and into a bowl or hand basin. Pour Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED to remove the foreign body by washing it the fluid from the nose end of the eye out with tears. to the outer corner to avoid accidentally Poisoning flushing the uninjured eye. • If it can be seen, it may be able to be Shock/Fainting removed by gently using the soft corner of If unsuccessful, cover the eye with a a moistened tissue. Make one attempt only. sterile pad and seek advice from the Spinal Injuries local doctor. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 63 1 of 6 Adult Resuscitation Fractures and Adult Defibrillation Symptoms and signs Child Resuscitation • Pain (severe or moderate, depending on the dislocations location of the injury) Baby Resuscitation • Swelling Background • Deformity of the injured area (when Special Resuscitation compared with the uninjured side of the When a bone breaks, it is called a fracture. CPR Chart Some fractures are complete, e.g. when a long body) bone snaps in half, whereas other fractures • Loss of normal function of the injured part Abdominal Injuries may involve only part of a bone breaking, • Discolouration of the skin or bruising e.g. the “greenstick” fracture of childhood. Asthma • A wound if it is an open fracture • Symptoms and signs of shock — see Shock. Allergic Reaction • Altered sensation, e.g. “pins and needles” Bites and Stings A fracture is called: if a nerve is under pressure, or a grating sensation if injured bone ends are rubbing • closed where there is no break in the skin. Bleeding together. Burns and Scalds

What to do — step by step Chest Injuries • open where the bone end has broken the skin or a wound is present with the fracture. Childbirth/Miscarriage Control any bleeding 1 Choking • If a wound is present, check for any bleeding. If bleeding is present it may not Cold Illness • complicated where an underlying organ is be severe because of pressure on nearby involved, e.g. a fractured skull with pressure blood vessels from the displaced bone Convulsions/Seizures on the brain, or when a broken rib has and soft tissues. injured the lung. Croup • Apply padding around the wound, or above and below the wound. Diabetes Drug/Alcohol Overdose Eye Injuries A dislocation is where a bone has been displaced from its normal position at a joint. Fractures/Dislocations Some joints are more likely than others to dislocate under a sudden force, e.g. the Head Injuries shoulder or a finger. As a general rule, a dislocation should be managed as a fracture. Heart Conditions Any injury that might involve either a fracture or dislocation should be treated with great Heat Illness caution. All movement of the part should be discouraged and first aid confined to providing Hyperventilation soft padding and support in the position chosen by the victim. In a remote area, or Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Do not apply direct pressure over where ambulance or medical care is likely to be delayed for an hour or more, the trained the wound. Poisoning first aider may use simple immobilisation • Apply a sterile dressing loosely over the techniques to reduce pain and spasm. In Shock/Fainting such cases, it is the first aider’s responsibility injured area and bandage it in place, but to monitor the circulation in any affected limb avoid any direct pressure on the wound Spinal Injuries to ensure that the immobilisation has not or broken bone. compromised blood flow or the nerve supply Call 000 or mobile 112 for an Sprains/Strains/Bruises to an extremity. ambulance. Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 64 Fractures and dislocations 2 of 6 Adult Resuscitation Adult Defibrillation 2 Immobilise the injured part Fractures and dislocations • Reduce the pain and the risk of further that need special care Child Resuscitation injury by supporting and immobilising the Baby Resuscitation injured area. Fracture of the face or jaw Special Resuscitation CPR Chart Although there is little that a first aider can do, fractures of the face and jaw have the Abdominal Injuries potential to be serious and need urgent medical assessment. Injuries to the face, Asthma e.g. from a punch, or a blow from a squash racquet, may involve damage to the bones Allergic Reaction of the cheek, forehead or bony orbit. These may be associated with a head injury or with Bites and Stings a serious eye injury which could lead to a permanent loss of sight. • Effective immobilisation requires an Bleeding injured body part to be splinted against A fractured or dislocated jaw may cause a an uninjured body part, although this risk of serious airway complications because Burns and Scalds of the loss of the ability to swallow. may not be necessary if an ambulance is Chest Injuries likely to be readily available. • If unconscious but breathing normally, Childbirth/Miscarriage 3 Make the victim comfortable place the victim on the side in the recovery position, with the injured side Choking • Help the victim into the position of downwards to assist with drainage of greatest comfort without any unnecessary Cold Illness fluids from the mouth. movement. Use blankets, pillows or clothing for general comfort and support. Convulsions/Seizures Call 000 or mobile 112 for an • Place generous padding around the ambulance. Croup injured area and in the nearby hollows of the body, using soft towels, clothing, • Ensure a clear airway until the ambulance Diabetes pillows or blankets, etc. arrives. Check for normal breathing every few minutes. Drug/Alcohol Overdose • If outside the metropolitan area where an ambulance may not arrive within an hour, • If conscious, allow the victim to rest Eye Injuries and if trained to do so, apply padding in the position of greatest comfort, and/or splinting to stabilise and immobilise generally half-sitting or lying down Fractures/Dislocations the injured part — see next section. with the head tilted to the injured side. Head Injuries Provide a clean pad or some tissues for Do not move the victim or any the victim to mop up any blood, saliva or Heart Conditions injured part unnecessarily. mucus. • If the jaw appears broken or dislocated, Heat Illness Treat to reduce shock 4 allow the victim to support the injured Hyperventilation • Keep the victim at total rest in a position part with one or both hands. of greatest comfort. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

• Loosen any tight clothing, but maintain Poisoning body heat. • Give frequent reassurance. Shock/Fainting Do not give any food or fluids to Spinal Injuries drink because an anaesthetic may be needed. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 65 Fractures and dislocations 3 of 6 Adult Resuscitation Fracture of the collarbone or Fracture of the ribs Adult Defibrillation dislocation of the shoulder joint Child Resuscitation The injury may involve a single broken A dislocated shoulder and fractured rib or several broken ribs. A rib fracture is Baby Resuscitation collarbone are managed in a similar way always associated with pain, especially when because both injuries disrupt the shoulder breathing in or coughing. Sometimes an Special Resuscitation joint, and the weight of the arm on the abnormal movement can be seen where injured side needs to be supported. Usually one part of the chest moves outwards when CPR Chart the victim will be supporting the arm on the the corresponding part on the opposite injured side and the shoulder will be lower side moves inwards, called a “flail chest”. Abdominal Injuries than the uninjured side, with the victim’s In a severe injury where the underlying lung head tilted towards the injury. The victim is has been damaged, the victim may have Asthma usually in severe pain and any unnecessary breathing difficulties or cough up blood movement should be avoided. — see Chest injuries. Allergic Reaction Bites and Stings • Use a pillow or folded clothing to allow • Assist the victim into a position of the victim to support the weight of the greatest comfort, usually half-sitting with Bleeding arm in the most comfortable position. support. Burns and Scalds Call 000 or mobile 112 for an ambulance. Chest Injuries • If severe pain or a “flail chest” is present, Childbirth/Miscarriage the first aider should apply improvised padding over the injured area and a Choking broad-fold triangular bandage as a binder to secure the arm to the chest wall Cold Illness over the padding. This will stabilise the moving segment of the rib cage and limit Convulsions/Seizures further internal injury. An Elevation Sling is used to support the arm on the injured Croup side — see Skills and Procedures, Slings. Diabetes Drug/Alcohol Overdose Eye Injuries • Check the pulse at the wrist every 10 Fractures/Dislocations minutes to ensure that the circulation is satisfactory. If the pulse cannot be found, Head Injuries ask the victim to change position slightly until the pulse is felt. Heart Conditions Call 000 or mobile 112 for an Heat Illness ambulance. Hyperventilation • Obtain prompt medical assessment because of the risk of damage to blood Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

vessels and nerves in the shoulder and upper arm areas. Poisoning • If ambulance transport is likely to be delayed, carefully immobilise the arm Shock/Fainting with padding under the armpit and apply Spinal Injuries either an Elevation Sling or an Arm Sling depending on the victim’s preferred Sprains/Strains/Bruises position — see Skills and Procedures, Slings. Stroke Skills and Procedures

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© 201 © INDEX 4 FIRST AID EMERGENCY eHANDBOOK 5th ed 66 Fractures and dislocations 4 of 6 Adult Resuscitation

Fracture of the upper arm • Additional support can be improvised Adult Defibrillation with soft padding between the arm and the body, with additional padding in the Child Resuscitation The victim usually supports the weight of the hollow where the waist meets the elbow elbow and lower arm to reduce the pain of joint. Fix the padding with narrow-fold Baby Resuscitation the injury. This fracture can be very serious bandages around the trunk and over the because of the risk of pressure on major injured arm, but above and below the injury. Special Resuscitation nerves and blood vessels, especially those close to the shoulder and elbow joints. Any CPR Chart unnecessary movement should be avoided. Abdominal Injuries

• Assist the victim into a position of Asthma greatest comfort, generally sitting in a chair or half-sitting with support. Allow Allergic Reaction the victim to support the arm on the injured side on a pillow or folded clothing. Bites and Stings • Check the pulse at the wrist at least every Bleeding 10 minutes to ensure that the circulation • Check the pulse at the wrist every 10 Burns and Scalds is satisfactory. minutes to ensure that the circulation Call 000 or mobile 112 for an is satisfactory. If there is any difficulty Chest Injuries ambulance. finding the pulse, urgent medical assessment is required. Childbirth/Miscarriage • If the ambulance is likely to be delayed, immobilise the injury with soft padding Choking slipped between the upper arm and the Fracture of the lower arm or wrist chest wall. Fix the padding with a narrow- Cold Illness fold bandage around the chest wall and either above or below the injury site. Apply These injuries are very common, especially Convulsions/Seizures an Elevation Sling with the minimum of in children and the older adult. The wrist is movement of the injured arm — see Skills often injured when a person falls onto an Croup and Procedures, Slings. outstretched hand. Normally the victim can support the injured arm using the other arm, Diabetes but additional immobilisation may be needed Fracture or dislocation of the elbow during transport to a doctor or hospital. Drug/Alcohol Overdose Eye Injuries The elbow joint can be injured in a fall or by • Assist the victim into the position of a sideways blow. The injury may result in the greatest comfort, usually sitting down Fractures/Dislocations arm being either totally straight or else bent supporting the weight of the injured at the elbow. The injury must be stabilised Head Injuries without any attempt to alter the position of limb against the body with the other the arm because of the possibility of serious hand. A pillow or rolled up clothing may Heart Conditions injury to major blood vessels and nerves be placed on the lap to provide a soft around the elbow joint. Usually the victim support for the victim to use to rest the Heat Illness will require ambulance transport to hospital weight of the arm. for prompt medical assessment and pain • Seek a prompt medical assessment. If Hyperventilation relief. ambulance transport is not used it is Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED usually necessary to immobilise the arm

• Assist the victim to either sit or lie down to avoid more pain and muscle spasm. Poisoning in the position of greatest comfort. Generally the victim will choose to lie Shock/Fainting down on the uninjured side and use the body as support for the injured area. Spinal Injuries Call 000 or mobile 112 for an Sprains/Strains/Bruises ambulance. Stroke Skills and Procedures

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© 201 © INDEX 5 FIRST AID EMERGENCY eHANDBOOK 5th ed 67 Fractures and dislocations 5 of 6 Adult Resuscitation • Apply a splint under the injured limb Fracture of the hip or lower leg Adult Defibrillation using a firmly rolled newspaper folded flat into a gutter shape. Hold the splint in Child Resuscitation place with narrow-fold bandage applied Injuries to the hip or lower limb can be very serious because of the risk of injury to major above and below the injury site, with an nerves and blood vessels. Usually there is Baby Resuscitation additional bandage if necessary. severe pain, spasm and shock. Unless there will be a significant delay in the arrival of Special Resuscitation an ambulance, it is best to use blankets and pillows for support along the limb. CPR Chart Abdominal Injuries • Try to make the victim as comfortable as possible lying down, but without moving Asthma the injured limb. Protect the victim from extremes of heat or cold and use a Allergic Reaction blanket or coat to maintain body heat. Bites and Stings Call 000 or mobile 112 for an • Apply an Arm Sling for additional support ambulance. Bleeding and stability — see Skills and Procedures, Slings. • Where there may be a wait of more than Burns and Scalds one hour for an ambulance, it may be Fracture of the hand and fracture necessary to immobilise the injured limb Chest Injuries to relieve severe pain and muscle spasm. or dislocation of a finger Pad well between the two legs, especially Childbirth/Miscarriage the hollows between the knees and Choking Injuries of the hand and fingers are common ankles. Move only the uninjured limb and in some sports. Although it is tempting to avoid any movement of the injured side. Cold Illness replace a dislocated finger to relieve the pain Tie the ankles together with a figure-of- and muscle spasm, there is a risk that a small eight using a narrow-fold bandage. Convulsions/Seizures nerve or blood vessel may be trapped and Fractured hip lead to a permanently numb or “dead” finger. Croup • Apply an extra broad-fold bandage • Apply generous soft padding around around the knees. Diabetes the hand or injured finger(s), like a winter mitten. Drug/Alcohol Overdose • Apply an Elevation Sling, taking care Eye Injuries to avoid touching the hand or fingers when tying the knot — see Skills and Fractures/Dislocations Procedures, Slings. Head Injuries

Fractured lower leg Heart Conditions • As for a fractured hip but place an extra Heat Illness broad-fold bandage around the thighs. • Depending on the injury site tie one or Hyperventilation two narrow-fold bandages around the lower leg, above and below the injury, Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

but not over the fracture site. Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Seek prompt medical assessment. Skills and Procedures

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© 201 © INDEX 6 FIRST AID EMERGENCY eHANDBOOK 5th ed 68 Fractures and dislocations 6 of 6 Adult Resuscitation

Fracture or dislocation of the Fracture or dislocation of the Adult Defibrillation knee joint ankle, foot or toes Child Resuscitation Baby Resuscitation Injury to the knee often occurs in a vehicle It is often difficult to decide whether an ankle joint is fractured or sprained and, accident where the knees strike the Special Resuscitation dashboard, and in body contact sports. whenever there is any doubt, the injury should be managed as a potential fracture. The injury is usually very painful with CPR Chart extensive muscle spasm. The foot and toes can be crushed by a heavy object, which results in a very painful and disabling injury. Abdominal Injuries • If the knee is dislocated or the kneecap damaged, apply light padding over the Asthma • Assist the victim to lie down and try to knee joint. Place support under the knee Allergic Reaction with a rolled sweater or towel to help raise the injured foot and ankle on soft padding as soon as possible to reduce ease the pain and muscle spasm. Raise Bites and Stings both knees on additional padding if pain and slow the onset of swelling. this can be done without adding to the Unless you suspect an open Bleeding victim’s pain. wound on the foot or toes, leave a well-fitting shoe in place because Burns and Scalds removal may further complicate the injury. Chest Injuries • If immobilisation is needed, use a soft Childbirth/Miscarriage pillow or rolled blanket around the foot and ankle. Apply two narrow-fold Choking bandages to hold the padding in place. Cold Illness Convulsions/Seizures Croup Call 000 or mobile 112 for an ambulance. Diabetes Drug/Alcohol Overdose • In a remote area where an ambulance is likely to be delayed for more than one Eye Injuries hour, immobilise the injured knee with narrow-fold bandages above and below Fractures/Dislocations the knee to stabilise the joint. Head Injuries Heart Conditions Heat Illness • Arrange for a prompt medical assessment, OR Hyperventilation Call 000 or mobile 112 for an ambulance. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 69 1 of 2 Adult Resuscitation Adult Defibrillation What to do — step by step Head injuries Child Resuscitation 1 Assess the victim Baby Resuscitation Background • Assess the victim’s conscious state. The brain is composed of soft tissue and is Special Resuscitation protected by the skull, which is a strong, • If unconscious and breathing normally, outer framework. The strength of the skull or not fully conscious and alert, place the CPR Chart is sufficient to protect the head from injury victim in the recovery position, preferably in a minor fall or a light blow to the head. If with the injured side downwards. If there Abdominal Injuries stronger forces are involved, e.g. from falling is any discharge from the ear, place a onto the head from a height, or being kicked sterile or clean pad underneath, but do Asthma by a horse, the skull may crack or fracture. not pack the ear canal. Concussion occurs Allergic Reaction when the brain is shaken violently inside Bites and Stings the skull. This results in the brain striking Bleeding the inside of the skull, resulting in bleeding or Burns and Scalds swelling and bruising. There may be no outer Chest Injuries sign of injury, but the damage to the brain is Childbirth/Miscarriage recognised by changes in behaviour caused Choking by increased pressure within the skull. Cold Illness Compression of the brain is a serious condition in which internal pressure can Convulsions/Seizures cause further injury. The pressure may be caused by a skull fracture, a collection Croup of blood, a tumour or infection. Clear or blood-stained fluid may be seen leaking from Diabetes the ear or nose and urgent admission to a hospital is required. Drug/Alcohol Overdose • Check every few minutes that the Eye Injuries airway is clear and normal breathing Symptoms and signs is present. Be prepared to begin Fractures/Dislocations • Altered conscious state, often deteriorating CPR if deterioration occurs — see over time Resuscitation. Head Injuries • Blurred or double vision • If conscious, encourage the victim to lie Heart Conditions • A thumping or pounding headache still because there is a possibility that a • Nausea or vomiting spinal injury may also be present with a Heat Illness • Loss of balance and hand-eye coordination head injury — see Spinal Injury, p. 68-69. Hyperventilation • Altered sensation in the fingers or down one side of the body Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Call 000 or mobile 112 for an • Loss of short-term memory, e.g. the memory  of recent events ambulance. Poisoning • Noisy breathing Shock/Fainting • A slow but strong pulse • Unequal pupils Spinal Injuries • Leaking fluid from the nose or one ear Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 70 Head injuries 2 of 2 Adult Resuscitation 2 Give care until arrival of the 4 Treat for shock Adult Defibrillation ambulance • Minimise shock by covering the victim Child Resuscitation lightly with clothing or a blanket. • Cover any wound with a sterile dressing. Baby Resuscitation •If there is any discharge from the ear or • Check for and treat any other injuries nose, cover the area with a sterile dressing. that may have been overlooked. Special Resuscitation • If fully conscious and alert, keep the head CPR Chart raised and supported to reduce further swelling and bruising around the brain. Abdominal Injuries Asthma Allergic Reaction Bites and Stings Bleeding Burns and Scalds Chest Injuries Childbirth/Miscarriage Choking 5 Until the ambulance arrives Cold Illness Do not pack the ear or nose • Stay with the victim and continue to Convulsions/Seizures with dressings because this can observe the conscious state, pupils, introduce infection and may breathing and pulse rates for any change. Croup increase the pressure on the brain. Always arrange for a doctor to Diabetes check the victim of a head injury Observe the victim even if it appears that a full Drug/Alcohol Overdose 3 recovery has occurred. • Observe the victim closely for any change Eye Injuries in condition. Note any change in the In many cases, a victim’s recovery conscious state, breathing and pulse from concussion may be followed Fractures/Dislocations rates, and be ready to begin resuscitation by some months of headaches, if necessary — see Resuscitation. tiredness, memory problems and Head Injuries the inability to concentrate. • If the victim appears drowsy and wants to This is particularly hard for a Heart Conditions sleep, assist into the recovery position person who is a student, and with injured side downwards. patience and understanding are Heat Illness • Check the pupils of the eyes and note required from parents, friends Hyperventilation any change in size or differences in size and colleagues. and reaction to light. Note anything that Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED appears to be unusual in the movement of the eyes — see Assessment of a sick Poisoning or injured victim. Shock/Fainting Never try to keep a person awake after a head injury. The victim Spinal Injuries may need to sleep for recovery and efforts to prevent this may Sprains/Strains/Bruises cause further bleeding or Stroke swelling around the brain. Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 71 1 of 2 Adult Resuscitation Heart Adult Defibrillation Child Resuscitation conditions Baby Resuscitation Special Resuscitation Blocked CPR Chart Background coronary A heart attack is one of the most serious artery Abdominal Injuries of several heart conditions that can lead to an emergency where lifesaving first aid is Asthma needed. A heart attack is also known as a myocardial infarct (MI) or by the old- Allergic Reaction fashioned term coronary thrombosis. Tissue When a heart attack occurs it is due to a damage Bites and Stings blockage in one of the coronary arteries that runs around the outside of the heart Bleeding to supply the heart muscle with blood. The severity of the attack depends on the Symptoms and signs Burns and Scalds location of the blockage: involvement of • Pain or an uncomfortable pressure in the a small blood vessel will cause chest pain middle of the chest that does not ease after Chest Injuries and other symptoms, but the victim should 10 minutes of rest recover after medical treatment. Blockage Childbirth/Miscarriage • The chest pain may: of a major blood vessel can lead to sudden death in which even the best first aid is ~ radiate up the neck and into the jaw Choking unlikely to save the victim’s life. and teeth Cold Illness An angina attack occurs where the victim ~ radiate into the shoulder or down one arm has narrowed blood vessels around the heart. ~ feel as if a crushing weight is resting on Convulsions/Seizures This is caused by fatty deposits (plaque) the victim’s chest being deposited along the vessel walls and Croup blood flowing with difficulty through those ~ feel as if a steel band around the chest is being tightened narrowed blood vessels. The pain of angina Diabetes usually occurs during exercise or exertion • Rapid breathing to reduce the pain and when an insufficient blood supply causes boost the oxygen supply to the heart Drug/Alcohol Overdose chest pain and distress. Most angina victims • A feeling of being short of breath and carry prescribed medication that will relax Eye Injuries the muscular walls of the affected blood needing to keep the head high vessels, allowing more blood to flow through • Rapid or irregular pulse rate with Fractures/Dislocations and relieve the pain. Angina may lead to a palpitations (but sometimes the pulse is heart attack one day and the victim should slower than normal) Head Injuries be treated as for a possible heart attack if a • Skin colour changes to either a pale or bluish dose of their prescribed medication fails to appearance Heart Conditions relieve the pain within a few minutes. • Feeling of light-headedness or fainting Congestive heart failure is a condition Heat Illness in which the heart muscle is permanently • Perspiration, especially on the head and face damaged from long-standing heart disease • Nausea Hyperventilation or old age. Inefficient pumping of the heart causes fluid to collect in the lungs, legs and • Feeling of great anxiety, weakness or fatigue Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED ankles, leaving the victim breathless and • A request for a dose of any medication unable to move briskly. Congestive heart previously prescribed for angina pain Poisoning failure is a long-term illness that rarely causes a sudden collapse requiring urgent and • Swollen legs or ankles if heart failure has Shock/Fainting lifesaving first aid. been previously diagnosed • Sudden collapse Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 72 Heart conditions 2 of 2 Adult Resuscitation What to do — step by step 3 Try to keep the victim calm Adult Defibrillation • Try to keep the victim calm because Child Resuscitation 1 Assist the victim to rest any stress or activity could cause complications or even collapse. • Help the conscious victim to rest in the Baby Resuscitation position of greatest comfort, generally • Loosen any tight clothing at the neck Special Resuscitation in a half-sitting position with support for and waist to assist breathing. the back and head. CPR Chart Abdominal Injuries Asthma Allergic Reaction Bites and Stings Bleeding

• If outdoors with no chair readily Burns and Scalds available, kneel behind the victim to Chest Injuries provide support while completing an 4 Observe the victim initial assessment. Childbirth/Miscarriage • Check the vital signs every few minutes until the ambulance officers arrive. Note Choking 2 Assess the victim any change in the breathing and pulse rates. • Assess the victim’s vital signs, including • Stay with the victim in case deterioration Cold Illness conscious state, breathing and pulse or collapse occurs. rates — see Assessment of a sick or Convulsions/Seizures injured person. Croup Defibrillator Call 000 or mobile 112 for an ambulance unless the pain Diabetes eases totally with the prescribed medication. When in doubt, Drug/Alcohol Overdose always send for an ambulance in Eye Injuries case collapse suddenly occurs. • Assist the victim to take any medication Fractures/Dislocations prescribed by a doctor for chest pain Head Injuries • Be ready to give CPR if collapse occurs If a victim of a heart attack collapses, a defibrillator may be needed to restore a — see Resuscitation. normal heart rhythm. If the heart muscle is Heart Conditions Avoid giving any food, fluids quivering (ventricular fibrillation) use of an automated external defibrillator (AED) may Heat Illness or stimulants such as alcohol, be life-saving. Call an ambulance as soon as cigarettes, tea or coffee because possible for any victim of a possible heart Hyperventilation this could cause further stress on attack in case defibrillation is needed. the heart and result in the victim’s Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED If an automated external defibrillator is available collapse. and first aid personnel have been trained in Poisoning Except in an extremely remote area, its use, standard CPR should be commenced and continued until the AED is completely Shock/Fainting ambulance transport is always ready for use. The first aiders should follow best for the victim because of the the audible prompts. An AED does not replace Spinal Injuries risk of collapse during travel. CPR but provides an extra step in emergency care — see also Adult Defibrillation. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 73 1 of 1 Adult Resuscitation

Call 000 or mobile 112 for an Adult Defibrillation Heat illness ambulance. Child Resuscitation Hyperthermia • If muscle cramps occur, gently stretch the affected muscles to ease the pain. Baby Resuscitation Background DO NOT give salt tablets or salt in Special Resuscitation Heat exhaustion occurs when the victim any form to the victim of heat illness becomes slightly dehydrated due to the because it is likely to cause vomiting CPR Chart constant loss of water in perspiration. and may result in other complications Replacement of the water loss usually Abdominal Injuries promotes a full recovery. Heat stroke is a potentially irreversible and 2 If heatstroke is suspected Asthma fatal response to exposure to extreme heat • Cool the victim using wet towels, or cover when the body is unable to maintain its the victim with a wet sheet and direct Allergic Reaction normal regulation of temperature. The victim is seriously dehydrated and no longer able to a fan across the surface. If shivering is Bites and Stings cool the skin surface by sweating. As the noted, stop the active cooling but leave internal body temperature rises, organ damage the wet towel or sheet in place. Bleeding occurs to the heart, brain and kidneys and • If ice packs are available, place them in toxins are released into the circulation as the the armpits and groins to aid cooling. Burns and Scalds major muscles “melt down”. Call 000 or mobile 112 for an Chest Injuries ambulance because hospital care is essential. Childbirth/Miscarriage Symptoms and signs • While waiting for an ambulance to arrive, • Initially the victim may have muscle cramps, Choking especially in the calves and toes give small drinks of water every 15 minutes. Cold Illness • Later there is exhaustion and general Avoid giving long drinks because weakness this may cause vomiting. Convulsions/Seizures • Nausea and/or vomiting • Keep the victim lying down at total rest Croup • Dizzy spells and avoid any physical activity. • Pale, cool and clammy skin at first, becoming • If the conscious state deteriorates, place Diabetes flushed and red later the victim in the recovery position and • Rapid and weak pulse and rapid, noisy continue whole body cooling until the Drug/Alcohol Overdose breathing. ambulance arrives. Eye Injuries • Check the vital signs at regular intervals, What to do — step by step particularly the breathing and pulse rate, Fractures/Dislocations which will be a guide to the victim’s progress. Be ready to begin CPR if Head Injuries 1 Replace lost fluids necessary — see Resuscitation. • Help the victim to lie down at total rest in Heart Conditions a cool area. Loosen any restrictive clothing Heat Illness at the neck and waist. Raise the legs slightly. • If the victim is fully alert and conscious, Hyperventilation give frequent small drinks of water. If the victim is too nauseated to drink, or is Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED actively vomiting, give ice chips to suck and arrange for prompt medical treatment. Poisoning • If unconscious or not fully conscious and Shock/Fainting alert, place the victim in the recovery position, check that the airway is clear and normal Spinal Injuries breathing present. Be ready to begin CPR if collapse occurs — see Resuscitation. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 74 1 of 1 Adult Resuscitation Hyperventilation Adult Defibrillation (Hysterical over-breathing) Child Resuscitation Baby Resuscitation • Advise the victim to try to slow the Background breathing rate and assist by counting Special Resuscitation Hyperventilation is a condition in which the each breath out loud, trying to reduce breathing rate is faster than normal, resulting the rate gradually. Encourage the victim CPR Chart in an imbalance in the levels of oxygen to match the counted rate and praise all and carbon dioxide circulating through the Abdominal Injuries body. Severe stress or anxiety can cause efforts made. the condition, which is why it is sometimes Asthma called “hysterical over-breathing”. However, Avoid asking the victim to because the condition can result from a re-breathe from a paper bag, Allergic Reaction serious illness that requires urgent medical which is dangerous and can assessment and treatment, it should be cause complications. Bites and Stings recognised that prompt medical advice is usually required. Bleeding Burns and Scalds Symptoms and signs • Rapid and shallow breathing Chest Injuries • Feeling of dizziness or being “light-headed” Childbirth/Miscarriage • Initial tingling of fingers and toes, followed by a numb feeling Choking • Anxiety and a feeling of being unable to breathe freely Cold Illness • Severe spasms of the fingers with the thumb • If the victim is successful at slowing the Convulsions/Seizures pulled into the palm of the hand (known as “carpopedal spasm”) breathing rate, a gradual improvement will be observed. The victim should be Croup able to relax and may be able to talk about any stress or personal problems Diabetes that caused the attack. Drug/Alcohol Overdose If the condition follows an injury,  appears serious, or is worsening, Eye Injuries call 000 or mobile 112 for an Fractures/Dislocations ambulance. If there is a possibility that poisoning might be involved or Head Injuries if the victim is a known diabetic, seek prompt medical advice. Heart Conditions Heat Illness Seek medical advice 2 Hyperventilation What to do — step by step • If the victim needs ambulance transport for medical assessment, check the level of Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED consciousness, breathing and pulse rates 1 Rest and reassure the victim every few minutes and note any changes. Poisoning • If the condition is likely to be caused by • If the condition is caused by stress, medical Shock/Fainting recent stress or anxiety, help the victim advice may be warranted after the victim to rest in a quiet area where there are no has recovered to avoid a repeat attack. Spinal Injuries bystanders or observers. • The victim should be encouraged to • Reassure the victim that the unpleasant discuss the event with the family doctor Sprains/Strains/Bruises symptoms will disappear when a slower or with a health counsellor if not in breathing pattern takes over. favour of seeking medical advice. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 75 1 of 2 Adult Resuscitation Adult Defibrillation What to do — step by step Mouth and Child Resuscitation tooth injuries 1 Assess the victim and the injury Baby Resuscitation • Check that the victim’s airway is clear. If there is any risk of blood going down Special Resuscitation the throat or of increased swelling of the Background mouth, tongue or throat, turn the victim CPR Chart Injuries to the mouth and/or teeth can result on the side into the Recovery Position Abdominal Injuries from a fall on the face or a direct blow, such and treat as for an unconscious victim. as a punch. A blow under the jaw can result in bitten lips or tongue. Such injuries can be • If the bleeding is only slow or moderate Asthma associated with severe bleeding, which can and there appears to be no breathing be a risk to the victim’s airway. Sometimes difficulty, assist the victim into the Allergic Reaction bleeding follows the extraction of a tooth position of greatest comfort, generally Bites and Stings when the initial clot breaks away from the sitting or half-sitting and check for the tooth socket. site of any bleeding. Bleeding If a tooth is knocked out in a collision or fall, the correct first aid may save the tooth. If Burns and Scalds it is replaced in the jaw and followed up by 2 Control any bleeding promptly prompt care from a dentist, it may survive. • Apply firm pressure to any bleeding Chest Injuries However, although a baby tooth from a wound or tooth socket. Fold a sterile small child is not replaced by the first aider, Childbirth/Miscarriage a dentist needs to check the mouth to avoid dressing or clean tissue into a pad and ask the victim to hold it firmly on the the risk of damage to the developing teeth. Choking bleeding site for at least 10 minutes. Swelling in or around the mouth can be associated with an injury or severe reaction Cold Illness to a bee or wasp sting. A venomous bite or sting in or around the mouth can have Convulsions/Seizures serious consequences. Sometimes the body’s allergic reaction to a venomous bite or sting Croup elsewhere may cause extensive swelling. This can cause obstruction to the throat and upper Diabetes airway for which prompt medical assessment and treatment are required — see Allergic Drug/Alcohol Overdose Reaction. Eye Injuries

Symptoms and signs Fractures/Dislocations • Bleeding from the mouth, lip, tongue or Head Injuries tooth socket • Pain around or in the mouth following Heart Conditions an injury Heat Illness • A broken or displaced tooth • Swelling in the mouth or around the jaw Hyperventilation • If bleeding is coming from a cut lip, Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

advise the victim to hold the injured area firmly between the folds of a moist Poisoning tissue or dressing. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 76 Mouth and tooth injuries 2 of 2 Adult Resuscitation

If a tooth has been knocked out: If the bleeding follows the extraction Adult Defibrillation of a tooth by a dental surgeon: • Ask the victim to suck it clean and then Child Resuscitation try to replace the tooth in the original • Ask the victim to bite down firmly over position in the socket to keep the root a pad that covers the tooth socket. If a Baby Resuscitation alive. A small piece of folded aluminium large, jelly-like clot is present, ask the foil may be used as a splint to fix the victim to have a mouthwash with salty Special Resuscitation tooth in place until a dentist is available. water to remove the clot, which will make it easier to stop the bleeding from CPR Chart the tooth socket. Abdominal Injuries • Continue to maintain pressure over the pad for at least 10 to 20 minutes to allow Asthma a new clot to form. Avoid giving any food or fluids Allergic Reaction to the victim because of the risk Bites and Stings of later complications if an anaesthetic is required. Bleeding 3 Obtain medical or dental advice Burns and Scalds and care Chest Injuries • If the injury involves a tooth or the jaw, Childbirth/Miscarriage arrange prompt transport to a dentist or dental hospital. Unless suffering Choking with severe shock the victim may be • Wrap the foil splint over at least one transported in a private vehicle in the Cold Illness tooth on each side of the replaced tooth. head up position. Ask the victim to bite down firmly on the • If the injury involves bleeding or swelling Convulsions/Seizures splint to keep the tooth root in contact of the mouth or throat, seek prompt Croup with the tissues of the jaw. medical advice. • If the victim cannot assist with If there is any risk to the airway Diabetes replacement of the tooth in the socket, from heavy bleeding or increasing try to keep the tooth moist and clean. swelling, call 000 or mobile 112 Drug/Alcohol Overdose Ask the victim to carry the tooth in the for an ambulance. mouth between the lower front teeth Eye Injuries and lip where it will be bathed in saliva. Fractures/Dislocations • If the victim is unconscious and it is 4 Observe the victim considered unsafe to carry the tooth in • Observe the victim’s level of Head Injuries the mouth, place it in a clean container consciousness at frequent intervals and with a little milk. Heart Conditions be prepared to begin CPR if necessary. DO NOT place the tooth in water Continue CPR until the ambulance Heat Illness because this can damage the arrives — see Resuscitation. membrane and cause the tooth Hyperventilation to be rejected by the body. Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED If a small child loses one of the

first ‘baby’ teeth, there is no need Poisoning to attempt replacement. However, prompt dental advice should be Shock/Fainting obtained in case the permanent tooth has been damaged in the jaw. Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 77 1 of 2 Adult Resuscitation Poisoning 2 Check the victim’s level of Adult Defibrillation consciousness Child Resuscitation If unconscious Baby Resuscitation Background • If breathing normally, turn the victim on A poison is a substance that causes injury, the side to clear and open the airway. Special Resuscitation illness or death if it enters the body. Poisons may enter the body in the form of liquids, CPR Chart solids, or gas and vapour fumes. Poisons can enter by: Abdominal Injuries • Ingestion through the mouth and digestive Asthma system • Inhalation of fumes through the lungs Allergic Reaction • Absorption of a chemical or plant extract through the skin Bites and Stings • Injection of drugs of abuse or by substances Bleeding from venomous creatures — see Bites and stings or Drug overdose. Burns and Scalds Chest Injuries Symptoms and signs • If not breathing normally, begin CPR Depending on the substance involved and — see Resuscitation. Childbirth/Miscarriage entry route, the following may occur: • If there are burns around the mouth, Choking • Nausea or vomiting wipe the area clean before starting CPR • Diarrhoea — see Resuscitation. Cold Illness • Profuse sweating Call 000 or mobile 112 for an Convulsions/Seizures • Abdominal pain ambulance immediately. • Unconsciousness or deteriorating conscious Croup state If conscious • Seizures • If the mouth is burnt from a corrosive Diabetes • Breathing difficulty poison, wipe the area with a moist cloth Drug/Alcohol Overdose or tissues. Eye Injuries General management of poisoning 3 Call the Poisons Information Centre Fractures/Dislocations Call 13 11 26 for specific advice on the Head Injuries 1 Check for safety before first aid management required. Follow approaching the victim all instructions concerning medical Heart Conditions advice or ambulance transport to • Ensure safety for yourself, victim and any hospital. Heat Illness others before approaching to give first aid. If safe and necessary, remove the • Check the victim’s level of consciousness Hyperventilation victim to a safer area. every few minutes and note any changes. • Note any information about the nature Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Do not give the victim anything of the poisoning incident, e.g. tablets, to eat or drink unless told to do Poisoning berries, burns around the mouth etc. so by the Poisons Information Centre consultant. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 77 Poisoning 2 of 2 Adult Resuscitation

Ingested (swallowed) poisons Absorbed poisons Adult Defibrillation Child Resuscitation In addition to the general treatment Check for safety before 1 Baby Resuscitation for poisoning, keep any evidence to go approaching the victim to hospital with the victim, e.g. tablets, containers, berries etc. • Help the conscious or semi-conscious Special Resuscitation victim to remove any contaminated clothing and wash all affected areas of CPR Chart

1Inhaled poisons the skin surface. The first aider should Abdominal Injuries avoid contact with the discarded clothing and skin of the victim, especially when Asthma 1 Check for safety before agricultural chemicals are involved. approaching the victim Allergic Reaction Call the Poisons Information Centre • If poisonous fumes are present in a (PIC) on 13 11 26 as soon as possible for Bites and Stings confined space, the victim needs to be specific advice on first aid management. moved into fresh air as soon as possible. Bleeding The first aider may need to enter the Call 000 or mobile 112 for an space if the victim is unconscious and ambulance. Burns and Scalds must be dragged to safety. However, the first aider should take no undue risks. Chest Injuries Injected poisons (excluding venoms) Childbirth/Miscarriage • Check the area for evidence of an injected Choking drug being used. Cold Illness Convulsions/Seizures Croup Diabetes Drug/Alcohol Overdose • When it is safe to do so, check the victim’s level of consciousness and give Eye Injuries general care for poisoning. Fractures/Dislocations • Keep any relevant items safe to assist with If a toxic chemical has been later identification of the substance taken. Head Injuries inhaled, there is no risk for the If the victim is conscious, be careful Heart Conditions first aider performing resuscitation to avoid direct contact because there in the open air but extra efforts may be rapid changes in mood with Heat Illness should be made to avoid all a quiet victim suddenly becoming exhaled air from the victim. violent and aggressive. Hyperventilation When moved into fresh air, the Unless the victim is recovering Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED victim may recover rapidly from rapidly and is in the care of a inhaled gases or fumes. However, responsible adult, call 000 or Poisoning some toxic chemicals can cause mobile 112 for an ambulance. serious problems once inhaled Shock/Fainting into the lungs and prompt medical assessment and Spinal Injuries treatment are required. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 79 1 of 2 Adult Resuscitation Shock and Adult Defibrillation Child Resuscitation

fainting What to do — step by step Baby Resuscitation Special Resuscitation 1 Assess and manage the injury or Background illness CPR Chart Shock is the body’s response to stress, e.g. sudden illness, injury, pain, fear or fright etc. • Check the victim’s level of consciousness: Abdominal Injuries If the stress is relatively minor, e.g. a cut finger, the body compensates quickly by increasing If unconscious Asthma the oxygen supply with an increased breathing ~ turn the victim on the side to clear and Allergic Reaction rate. In addition, the heart rate increases open the airway to circulate the extra oxygen around the body and especially to the vital organs including the ~ if normal breathing is absent begin CPR Bites and Stings heart muscle itself, the lungs and the brain. — see Resuscitation. Bleeding To boost the oxygen supply to the vital organs, • Control any obvious bleeding — see the smaller blood vessels throughout the body Bleeding. Burns and Scalds constrict to allow blood to be withdrawn from the skin surface and digestive tract. This may Call 000 or mobile 112 for an Chest Injuries result in pale, cold and moist skin, with nausea ambulance. or vomiting as blood leaves the stomach. Childbirth/Miscarriage If the victim has lost a significant amount of If conscious blood through a major wound, or is severely • Assist the victim into the position of Choking dehydrated owing to vomiting, diarrhoea, heat greatest comfort, preferably lying down. stroke or extensive burns, the body may not be Cold Illness able to compensate with additional blood flow • Loosen any tight clothing at neck and although the heart rate increases. When this waist to help the victim relax and obtain Convulsions/Seizures happens the degree of shock experienced may more oxygen. be severe or even life threatening, due to the Croup eventual collapse of the circulation. Fainting is a condition in which a person loses Diabetes full consciousness caused by blood pooling in the legs and not reaching the brain. It can Drug/Alcohol Overdose result from prolonged standing in one position, especially on a hot day, or following pain or an Eye Injuries emotional upset. A person who is suffering a fainting attack is likely to have a slow pulse. Fractures/Dislocations Head Injuries Symptoms and signs may include: Heart Conditions • Rapid breathing rate (called “air hunger” Heat Illness in severe shock) • Weak and rapid pulse rate in shock Hyperventilation • Slow pulse in fainting • Pale, cool and “clammy” skin Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

• Nausea or vomiting Poisoning • Anxiety, confusion & restlessness • Cool a burn or scald and cover any • Deteriorating level of consciousness wounds with a sterile dressing — see Shock/Fainting Burns and scalds. Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 80 Shock and fainting 2 of 2 Adult Resuscitation 2 Reassure the victim at frequent • If the victim complains of severe thirst, Adult Defibrillation intervals but avoid discussing moisten the lips with a damp cloth, or Child Resuscitation any injuries give an ice chip to suck. Avoid giving the victim any food, Baby Resuscitation In shock, the victim is often fluids or stimulants such as alcohol unaware of the extent of any or a cigarette. In severe shock the Special Resuscitation injuries received. Avoid drawing victim is unable to digest food and CPR Chart attention to the illness or injury may have an injury that requires because this may add to the an operation under an anaesthetic. degree of shock. Abdominal Injuries Obtain medical help Asthma 3 Check the victim’s level of 5 consciousness and other signs • Ensure that an ambulance has been called Allergic Reaction for any major incident where shock or of life every few minutes and Bites and Stings note any changes the underlying illness or injury is severe. • If the underlying condition is minor, e.g. Bleeding a cut finger, the degree of shock may not 4 Maintain body temperature be severe and the victim should respond Burns and Scalds to a period of rest and reassurance. • Maintain a normal body temperature as Chest Injuries far as possible, depending on weather • When the victim has recovered arrange conditions. If it is cold or wet, place a for medical advice and treatment, Childbirth/Miscarriage blanket, coat or newspapers under and depending on the illness or injury. over the victim to reduce heat loss. If it is Choking a warm day, cover the victim lightly and Fainting try to provide shade without moving the 6 Cold Illness victim, if possible. • Manage the victim as for shock but, if conscious and responding to your voice or Convulsions/Seizures touch, raise the legs to boost the return of blood to the heart. Croup Diabetes Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions

On a hot day the surface on which Heat Illness the victim is lying may cause • If the victim's conscious state deteriorates, Hyperventilation further injury, including surface turn on the side to clear and open the airway. burns. Always check the surface Mouth/Tooth Injuries When in doubt about the severity UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

on which the victim is lying to avoid the risk of further injury. of the victim’s condition, always Poisoning call for an ambulance. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 81 1 of 2 Adult Resuscitation What to do — step by step Adult Defibrillation Spinal injuries Child Resuscitation 1 Assess the victim • Check the victim’s level of consciousness: Baby Resuscitation Background Spinal injuries may be caused by any strong If unconscious and breathing normally Special Resuscitation forces affecting the head, back, chest, feet ~ turn the victim onto the side in the CPR Chart or legs. A person falling from a height may recovery position, avoiding any forwards land in a range of positions. The spine is movement of the head and neck often jarred even when the victim lands face Abdominal Injuries down on the chest. A road traffic accident is ~ if possible, especially if a helper is available, a common cause of spinal injury, where the support the head during the turn, but do Asthma victim is a passenger in a vehicle involved in a not delay making the turn to do so. collision or where a moving vehicle strikes a Allergic Reaction pedestrian or other road user. Bites and Stings A spinal injury may occur in sport or recreation, especially in a body contact sport Bleeding such as rugby, or from striking a submerged object when diving into shallow or murky Burns and Scalds water. In severe cases, the victim may be paralysed below the level of the injury, e.g. Chest Injuries from the waist downwards for a mid or lower back injury (becoming a paraplegic), or from Childbirth/Miscarriage the neck and shoulders downwards if the injury involves the neck spine (becoming a Choking quadriplegic). If the victim is paralysed and floating face down in water, death will occur Cold Illness unless a rapid rescue is performed. Injuries to the spine are often associated A clear and open airway always Convulsions/Seizures with a head injury and this must be taken takes priority over any possible Croup into account when assessing the victim and injuries, including a spinal injury. managing the injury. A person may die quickly from an Diabetes obstructed airway, whereas the spinal injury may not be as serious Drug/Alcohol Overdose as bystanders anticipate. Symptoms and signs Eye Injuries • Pain in the head, neck or down the spine Call 000 or mobile 112 for an ambulance. • Altered sensation, tingling/numbness of Fractures/Dislocations fingers or toes If conscious Head Injuries • Loss of power/function in the upper and/or • If a bystander is available, ask the person lower limbs to hold the victim’s head still. Heart Conditions • Altered level of consciousness Heat Illness • Bleeding or blood-stained fluid leaking from an ear/nose Hyperventilation • Headache Mouth/Tooth Injuries • Giddiness and loss of balance and UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

coordination Poisoning • Nausea or vomiting • Wounds or bruising in the area of impact. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 82 Spinal injuries 2 of 2 Adult Resuscitation • Carefully assess the victim’s injuries Spinal injury in water Adult Defibrillation without any unnecessary movement • Check first for any bleeding wounds Child Resuscitation If a spinal injury is suspected in a conscious and apply a pressure dressing to avoid Baby Resuscitation unnecessary blood loss victim seen floating in water, first aid management includes caring for the victim in • Cover any minor wounds to protect the water until the arrival of an ambulance. Special Resuscitation against further injury. CPR Chart Note any obvious deformity of Any attempt to remove the conscious limbs, hands or feet and use victim from water without adequate Abdominal Injuries improvised padding to support and trained personnel and equipment Asthma the injured area without moving may cause serious or even fatal the victim. complications to a spinal injured Allergic Reaction person. Unless in very rough water, e.g. Rest and reassure the victim at sea, it is always best to leave the Bites and Stings 2 victim safely supported by a strong • Reassure the victim that trained swimmer in the water. Bleeding assistance is on the way. A conscious but totally paralysed Burns and Scalds • Try to make the victim as comfortable as victim is unable to change position possible without moving the head, neck unaided and may drown unless Chest Injuries or spine. turned over promptly. Childbirth/Miscarriage As a general rule, ask the conscious person to move a limb while 1 Support the victim’s head, neck Choking something is placed underneath. and upper body to keep the DO NOT attempt to move any part airway clear of the water Cold Illness of the body yourself, even if trying to make the victim more comfortable. Convulsions/Seizures For example, if the victim can lift 2 Maintain a straight alignment of Croup the head enough for you to place the spine soft padding underneath there is Diabetes little risk of further injury. • Tow the victim with traction on the head and neck. It is easier to maintain traction • Maintain body temperature with a Drug/Alcohol Overdose and flotation while towing the victim suitable covering over the victim. If the gently. Avoid any violent movements weather is either very hot, cold and/or Eye Injuries or sudden changes in direction. wet, gently ease some clothing or Fractures/Dislocations newspaper under the limbs and head to avoid transfer of heat or cold from the Head Injuries underneath surface to the victim’s body. Heart Conditions 3 Observe the victim for Heat Illness any change in the level of consciousness Hyperventilation • Check the level of consciousness every Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED few minutes and note any changes. Poisoning • If there is any deterioration in the If the victim is unconscious conscious state do not hesitate to roll the 3 Shock/Fainting victim onto the side to protect the airway. • Remove the victim from the water without delay and check for normal Spinal Injuries breathing. If necessary start CPR — see Resuscitation. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 83 1 of 2 Adult Resuscitation What to do — step by step Sprains, strains Adult Defibrillation 1 Assist the victim into a Child Resuscitation comfortable position and bruises Baby Resuscitation • Assist the victim into the position of greatest comfort, generally sitting with Special Resuscitation support or lying down. Background CPR Chart • Raise the injured area if possible to limit Injuries that involve body tissues apart from any further bleeding into the damaged bone are generally classified as soft tissue Abdominal Injuries injuries. Sprains, strains and bruises are all tissues. For a sprained ankle or strained soft tissue injuries, although the cause and calf muscle, raise and support the lower Asthma tissues involved in each injury are different. limb on padding made of rolled up clothing or a blanket, etc. For an injured Allergic Reaction A sprain is an injury that involves the arm or wrist, support it in a raised ligaments and other soft tissues around Bites and Stings a joint, such as an ankle or wrist. position or rest the limb on some rolled up clothing or a pillow. A strain occurs away from a joint and involves Bleeding a torn or over-stretched muscle or tendon, commonly in the calf, thigh or lower back. Burns and Scalds A bruise is a soft tissue injury that involves Chest Injuries the skin and nearby tissues following a blow or other forces that break a blood vessel close Childbirth/Miscarriage to the surface of the body. Bruising may be seen with a sprain or strain. The colour of the Choking tissues may indicate the time of the injury: initially the tissues are reddened, then change Cold Illness to purple and, as the blood is slowly absorbed back into the body, the tissues become bluish. Convulsions/Seizures A dislocation is where a bone has been displaced from its normal position at a joint. Croup Some joints are more likely than others to dislocate under a sudden, severe force, e.g. • If the victim is visibly shocked, with pale, Diabetes the shoulder or a finger joint. As a general cold and clammy skin, elevate the injured rule, a dislocation injury should be managed area but try to keep the victim lying down. Drug/Alcohol Overdose as a fracture — see Fractures. Eye Injuries 2 Apply a firm supporting Fractures/Dislocations Symptoms and signs bandage Head Injuries • Pain at the site of the injury, often severe • Use a good quality crepe or elasticised with a sprain or strain crepe roller bandage on an injured limb. Heart Conditions • Loss of power in the injured area, especially • Ensure that firm and even pressure with a sprained joint Heat Illness is applied to the injured part without • Swelling of injured area slowing the circulation of blood to the Hyperventilation • Nausea fingers or toes of the affected limb. • Feeling faint or giddy • If the injured part is too painful or Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED swollen to apply a bandage, use cotton • Pale, cold and clammy skin, due to shock wool padding around the injury first Poisoning and bandage firmly over it. Leave the Shock/Fainting bandage in place for at least 10 minutes. Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 84 Sprains, strains and bruises 2 of 2 Adult Resuscitation Adult Defibrillation Never apply an unwrapped ice pack directly over the skin surface Child Resuscitation because it may cause a burn or complicate the existing injury. Baby Resuscitation Never use an ice pack for longer Special Resuscitation than 10 minutes at a time on a child or older adult. On any victim CPR Chart always check the colour of the skin Abdominal Injuries at frequent intervals. Remove the ice pack if the skin changes from Asthma • If the injury is not on a limb, apply firm white or blue to a pink or red hand pressure over a bulky pad for at colour because this indicates an Allergic Reaction least 10 minutes. increased blood flow to the part, which will cause more internal Bites and Stings bleeding. 3 Apply an ice pack to the injured Bleeding area 4 Keep the injured area at total Burns and Scalds • After 10 minutes of compression, rest and arrange for medical elevation and rest apply a wrapped ice advice Chest Injuries pack over the injured area. • Ensure total rest with elevation of the Childbirth/Miscarriage • If a prepared ice pack is not readily injured area for the first 20-30 minutes available, fill a plastic bag with crushed following the injury. This will allow initial Choking ice and seal it well. Alternatively, a pack control of any bleeding into the tissues. of frozen vegetables may be used if ice is Cold Illness not available. • Arrange for a prompt medical assessment of the injury. Convulsions/Seizures If the victim is still shocked and Croup in severe pain, or unable to be assisted to a car for transport, Diabetes call 000 or mobile 112 for an ambulance. Drug/Alcohol Overdose If the injury involves the lower back Eye Injuries or neck, an ambulance is the best form of transport to avoid Fractures/Dislocations the risk of further injury. Head Injuries Avoid the use of heat packs and warmth until the tissues have Heart Conditions • Leave the ice pack in place for no more regained normal skin temperature, than 10 minutes. Then remove it and which usually takes two or three Heat Illness reapply the supporting crepe bandage. days. Application of heat in any form while the injured part feels Hyperventilation • When the skin has regained a normal or hot to the touch may cause more warm temperature to touch, the ice pack Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED bleeding into the injured tissues. may be reapplied for no more than 10 minutes at a time. An ice pack should not Avoid the use of an ice pack Poisoning before the victim has had 10 be reapplied if the skin still feels cold to Shock/Fainting the touch. minutes of compression with a bandage, elevation of the part Spinal Injuries and rest. Ice packs can delay clotting and thus may prolong the Sprains/Strains/Bruises bleeding into the injured area. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 85 1 of 2 Adult Resuscitation Stroke Adult Defibrillation Child Resuscitation Background Symptoms and signs Baby Resuscitation A stroke is a condition in which part of the • Moderate to severe headache brain is affected by an interruption to the Special Resuscitation normal blood supply. This can result from • Tingling, weakness or numbness down a clot in a blood vessel that stops blood one side of the body CPR Chart passing through to brain tissue. If this • Loss of muscle tone of the face muscles, condition is recognised at an early stage with dribbling from one side Abdominal Injuries and hospital care is readily available, drug • Nausea treatment is available to dissolve the clot, Asthma resulting in a full recovery. • Unequal pupils; blurred or double vision Allergic Reaction Sometimes a stroke is caused by a burst • Loss of bladder or bowel control blood vessel when the internal bleeding • Loss of speech or the uttering of Bites and Stings in the skull causes pressure on brain tissue. meaningless sounds At first, the victim may have a severe Bleeding headache but it can lead to paralysis down • Loss of balance and coordination one side of the body and even the loss of • Deteriorating conscious state or Burns and Scalds the ability to speak. unconsciousness Occasionally a person may have a minor Chest Injuries stroke in which there is weakness down one side of the body and/or loss of speech What to do — step by step Childbirth/Miscarriage for a few minutes only. This is called a transient ischaemic attack (TIA) and is Choking usually followed by a full recovery. Other 1 Assess the victim’s level of attacks may happen later and a major consciousness Cold Illness stroke may occur at any time. • If unconscious and breathing normally, Convulsions/Seizures or if not fully alert, place the victim in the recovery position but with the weak Croup or affected side downwards. Diabetes

Blocked artery Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations

Ruptured artery Head Injuries Heart Conditions Use the concept of FAST to assess three specific signs of stroke: Heat Illness Facial weakness - can the person smile? Does the mouth or eye droop? Hyperventilation Arm weakness - can the person raise both Mouth/Tooth Injuries arms? • Check the airway and breathing every UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED few minutes. Be ready to begin CPR if Speech problems - can the person speak Poisoning clearly and understand what you say? required — see Resuscitation. Time to act fast - call 000 or 112 for an Call 000 or mobile 112 for an Shock/Fainting ambulance. ambulance.  Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 86 Stroke 2 of 2 Adult Resuscitation Adult Defibrillation 2 Care for a conscious victim Check the victim’s level of 3 Child Resuscitation • Assist a conscious victim into the consciousness, breathing and position of greatest comfort. pulse rates every few minutes Baby Resuscitation • Note any changes and, if there is any Whether lying down or half- Special Resuscitation sitting, keep the head raised and deterioration in the victim’s conscious state, turn the victim into the recovery supported to reduce any CPR Chart additional pressure on the brain. position and check the airway and breathing every few minutes. Be Abdominal Injuries • Reassure the victim that you will stay prepared to begin CPR if necessary until an ambulance arrives. If the victim — see Resuscitation. Asthma is very distressed by loss of muscle tone and function, or loss of normal speech, It is vital to obtain urgent ambulance Allergic Reaction maintain reassuring contact by holding transport to hospital because medical the victim’s hand on the unaffected side. treatment for a stroke caused by a Bites and Stings clot in a blood vessel must be started • Using the FAST concept, assess any loss within two hours to be totally successful. Bleeding of muscle tone or weakness down one As this “clot buster” treatment cannot side. Look for any drooping of the eyelid be given to the victim of a bleeding Burns and Scalds or facial muscles and any dribbling of vessel in the brain, a number of tests saliva. If the victim cannot control saliva have to be carried out beforehand to Chest Injuries in the mouth due to loss of swallowing ensure that the correct treatment is given. and coordination, tilt the head slightly to Childbirth/Miscarriage the affected side and provide a cloth or Although the experience of suffering tissues to absorb any secretions. a stroke is very frightening for the Choking victim, if prompt medical treatment is given followed by rehabilitation Cold Illness therapy over a period of time, Convulsions/Seizures improvement is achievable for many victims. Croup Diabetes Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Heart Conditions • Note any speech difficulty or inability to speak coherently. If the victim is making Heat Illness mumbled sounds and is distressed by the inability to communicate, keep giving Hyperventilation reassurance that the problem may not be permanent. Encourage the victim to rest Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED quietly without trying to speak. Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 87 SKILLS AND PROCEDURES Adult Resuscitation Principles of first aid Adult Defibrillation Child Resuscitation First aid emergency, or as a designated child carer in a school or kindergarten. In these examples it is clear that there Baby Resuscitation First aid is the care given to a victim of illness must be provision for first aid facilities to be available to or injury until the arrival of an ambulance officer, the victims of an emergency when it is unlikely that the Special Resuscitation nurse or doctor. individual concerned is able to apply self-help first aid. The four aims of first aid are to: CPR Chart If a duty of care relationship exists the first aider • Preserve life by keeping the victim safe and Abdominal Injuries giving correct first aid should not be intimidated by fears of litigation. • Protect the unconscious victim who may need The first aider should give emergency care that is: Asthma correct positioning or resuscitation • Prevent the condition from worsening by ~ prudent and reasonable in the circumstances Allergic Reaction giving lifesaving first aid ~ in the best interests of the victim • Promote recovery by controlling bleeding or ~ based on skills and knowledge acquired during Bites and Stings giving resuscitation, as required. formal first aid training ~ unlikely to make the victim’s condition worse, Bleeding or complicate the illness or injury. Cultural awareness and respect Burns and Scalds For these reasons, the first aider should confine any When assisting a sick or injured person the first emergency actions to those contained in a reputable Chest Injuries aider should show respect and be aware of first aid manual and use only equipment for which cultural issues. English may not be their first full training and accreditation has been given. Childbirth/Miscarriage language and a woman might be uncomfortable accepting first aid from a man etc. In some In another example, if a person is involved in a road Choking cultures direct eye contact may be impolite. accident, e.g. as a driver or cyclist, in all States and Cold Illness Territories there is a legal requirement to: Legal implications of first aid • stay at the scene Convulsions/Seizures For specific information on the legal implications • assist the injured (to the best of your ability) of giving first aid to another person it is • report the incident to police. Croup recommended that any individual should seek Diabetes advice from a registered legal practitioner. The Consent is another legal consideration. If the victim is following material should be used only as a conscious, consent should be sought from the victim Drug/Alcohol Overdose guide to the legal implications relevant to first before any first aid treatment is started. If the victim aid in an emergency. is under the age of 18, consent should be obtained Eye Injuries from a parent or guardian but, if the child is A first aider may be an off-duty nurse or an unaccompanied, first aid should be given in good Fractures/Dislocations untrained bystander but, under Common Law, faith. If the victim is unconscious consent is assumed any person who sees an emergency may decide and first aid should be given. However, any first aid Head Injuries to assist the victim of sickness or injury until should be confined to essential care and be within the more highly trained assistance becomes scope of your first aid qualifications. Heart Conditions available. As a general rule, a first aider should only hand over responsibility for care of the Negligence is often a major concern for the first Heat Illness victim to a doctor, nurse or ambulance officer. aider, despite the fact that it is unlikely that any victim Hyperventilation In the interim there are four considerations that would later attempt to sue the person who the first aider should consider in an emergency: administered care in an emergency. Although such Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED 1. Duty of care action is unlikely, it would be up to a court to decide 2. Consent whether the first aider was guilty of gross negligence Poisoning 3. Negligence resulting in further harm to the victim. To date in 4. Recording Australia there has been no successful litigation Shock/Fainting against a first aider. In most State and Territory There is no legal obligation to assist a sick or legislation there is a "Good Samaritan" clause that Spinal Injuries injured person in an emergency unless a duty of covers the situation in which a first aider does their care relationship exists. ‘Duty of care’ is phrase best in an emergency whatever the outcome. This Sprains/Strains/Bruises that outlines the legal relationship owed by eon clause relates only to first aid treatment for which Stroke individual to another, e.g. as the designated there is no fee charged. workplace first aid officer in a workplace Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 88 SKILLS AND PROCEDURES Adult Resuscitation Recording is a legal responsibility for any incident, If the first aider is employed to give first aid, whether major or minor. It is essential that the e.g. as a first aider in a large industry, then that Adult Defibrillation first aider records the details of any incident at person has a legal duty of care to give first aid to which first aid is given. Such records may be used any victim of illness or injury at that workplace. Child Resuscitation to protect the first aider at a later date and may This requires the designated first aider to attend be used in court in some circumstances. Thus any regular revision sessions to maintain their level Baby Resuscitation report should be: of first aid competence and to ensure that their qualifications remain current at all times. Special Resuscitation ~ written in ink (and not in pencil or altered with correction fluid) In addition to carrying out first aid treatments, CPR Chart ~ signed and dated by the first aider the person who is designated as the workplace Abdominal Injuries ~ without alterations unless these are made in ink first aider has several other duties, including: and initialled by the first aider • completing and filing accident and illness reports Asthma ~ kept confidential unless requested by a legally • reporting of hazards highlighted by an authorised person. occurrence where first aid has been needed Allergic Reaction • notifying any treatment trends, e.g. frequent Bites and Stings Workplace first aid eye strain reports or requests for analgesics • referring victims to an appropriate medical Bleeding In all States and Territories there is Workplace facility after treatment has been given Health and Safety legislation that requires employers • cleaning and restocking the first aid room and/ Burns and Scalds to provide first aid for any employee who is injured or first aid kits. or becomes ill at work. This legislation varies across • maintaining confidentiality to ensure that Chest Injuries Australia depending on whether it is a Regulation, personal information is not discussed with Code of Practice or Advisory Standard under an other employees. Childbirth/Miscarriage Work Health and Safety Act. But the impact is the same. First aid kits should be checked regularly and Choking especially after any first aid has been given. These For example, the legislation can require a large work checks should include a survey of expiry dates Cold Illness place to provide a first aid room in which an on any items, which is especially important for Occupational Health Nurse or First Aider carries out solutions including antiseptics and eye treatments, Convulsions/Seizures first aid treatments. The requirements for first aid and such as normal saline irrigation fluid. Some Croup first aid equipment are based on a process of risk consumable items may be purchased in bulk for assessment in each area of work. Thus the employer economic reasons, but the first aider should Diabetes is obligated to determine the following requirements maintain each kit to the level that complies with for the individual workplace including the: local legislation. Replenishment items should be Drug/Alcohol Overdose kept in a locked cupboard to assist the first aider • number and distribution of employees and their to refill the kit at any time after use. It is prudent Eye Injuries working shifts, including access to emergency to maintain a record of first aid kit checks, especially telephone or radio communications etc. in a large workplace. This process can be simplified Fractures/Dislocations • nature of the work being performed, which will by introducing a numbering system for each kit, Head Injuries vary from one worksite to another in a large which will also aid in tracking any kits that have enterprise been moved to another location. • identification and risk yof an hazardsinthose Heart Conditions worksites and the nature of that risk Finally, the designated workplace first aider must Heat Illness • locations of the worksite, whether in a ensure that full training has been given for any metropolitan area or at a remote location, item of first aid or emergency equipment used Hyperventilation and the anticipated time for any emergency in the workplace. Unless trained in the use of assistance to reach the victim a stretcher or oxygen it is wise to wait for the Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED • known previous occurrences of accidents or arrival of an ambulance before attempting to illness, including any recorded “near-miss” events use this equipment. Poisoning • selection and availability of first aid equipment and associated staff training Shock/Fainting • written policies and procedures for the management of any emergency, including the Spinal Injuries provision of translated versions to meet the Sprains/Strains/Bruises language requirements of any employees for whom English is not their first language. Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 89 SKILLS AND PROCEDURES Adult Resuscitation Assessment of a sick or injured person Adult Defibrillation Child Resuscitation In any emergency and when it is safe to do so, 1 Ask the victim and any bystanders for the Baby Resuscitation the first aider should: history of the problem, outlining what happened, the time of onset and whether ~ assess the area Special Resuscitation there is any known underlying health problem, ~ assess the victim. such as asthma, diabetes, epilepsy or heart CPR Chart condition. Quickly check for a Medic Alert bracelet or necklet, which may list any major Abdominal Injuries Assessment of the health problem. emergency area Asthma You may be alerted to the possibility of an Allergic Reaction emergency by various unusual sights and Bites and Stings sounds, or by seeing a person who appears to be either sick or injured. Bleeding Before assessing the victim, it is vital to check that the area is safe for you, the victim and Burns and Scalds bystanders. Chest Injuries Hazards might include: Childbirth/Miscarriage • traffic — see Road accidents Choking • electricity, both high and low voltage 2 Ask the victim to describe any Symptoms, — see Electricity including pain, soreness or discomfort and any Cold Illness other unusual sensations such as numbness or • deep water or rough, fast-flowing water tingling in the fingertips. Convulsions/Seizures — see Water Check the victim carefully, looking for 3 Croup • poisonous gases, chemicals or fumes any Signs of injury or illness, basing your — see Chemicals observations on the history and any symptoms Diabetes • fire — see Fire described. After an injury, look for any of the following: Drug/Alcohol Overdose • bleeding Assessment of a sick Eye Injuries • bruising or injured person Fractures/Dislocations • wounds Assess the nature of any injury or illness and set • swelling Head Injuries priorities for the care required. • deformity (when one side is compared with If the victim appears collapsed, first check the Heart Conditions the other) victim’s response to a shouted command and to a firm squeeze of the shoulders.If the collapsed • loss of power or function. Heat Illness victim does not respond, then be prepared to 4 Depending on the outcome of your initial Hyperventilation resuscitate — see Resuscitation. assessment, refer to the relevant page of this If the victim responds to your voice, then obtain handbook for management of bleeding, a Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED their consent and plan any emergency treatment wound, chest pain, asthma etc. Poisoning required. 5 When initial treatment has been given, Unless the injury or illness appears to be trivial, maintain close observation of the vital signs Shock/Fainting ask a bystander to call 000 or mobile 112 for every few minutes to indicate any change in an ambulance and then follow these simple condition or deterioration requiring a change Spinal Injuries in management. steps: Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 90 SKILLS AND PROCEDURES Adult Resuscitation

The vital signs are assessed Adult Defibrillation as follows: OBSERVATION CHART Child Resuscitation Full name Date • Conscious state: check the conscious state Baby Resuscitation approximately every few minutes and note any Department Time am/pm changes, especially any deterioration. Check Special Resuscitation if the victim is fully conscious and responding Time coherently, or only semi-conscious e.g., Conscious Fully conscious CPR Chart groaning. state Semi-conscious Abdominal Injuries • Airway: ensure that it is clear and open and that the victim does not have any secretions that Unconscious Asthma might obstruct breathing Temperature °C Allergic Reaction • Breathing: check for normal breathing; note Pulse Rate the rate and rhythm for any changes. Check Bites and Stings whether the breathing is deep or shallow, quiet Rhythm or noisy, and whether there are any abnormal Volume Bleeding sounds such as wheezing on breathing out. This is especially important with the unconscious Respiration Rate Burns and Scalds victim because any change may be a warning of Rhythm deterioration. Chest Injuries Depth Childbirth/Miscarriage Sound Choking Skin Colour

Condition Cold Illness Temperature Convulsions/Seizures Croup

• Circulation: note any changes in the pulse as a Handover communication Diabetes guide to progress. Check whether the pulse is with emergency services Drug/Alcohol Overdose fast or slow, strong or weak, regular or irregular. personnel In both the unconscious victim who is Eye Injuries breathing normally and the conscious person, the pulse should be checked at the underside of When handing over care to emergency Fractures/Dislocations the wrist on the base of thumb. services personnel, include: • name and details of the victim Head Injuries • summary of the incident Heart Conditions • time frames around the incident Heat Illness • any previous medical history (if known) • any emergency care given. Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning • Skin: look at the skin and note the colour (whether tinged with blue), and feel whether Shock/Fainting it is hot (with fever) or cold and clammy (as in shock). Spinal Injuries If deterioration occurs, turn the victim on Sprains/Strains/Bruises the side into the recovery position. Stroke Call 000 or mobile 112 for an ambulance. Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 91 SKILLS AND PROCEDURES Adult Resuscitation New homes are required to install Residual Adult Defibrillation Current Devices (RCDs) or special Safety First aid and safety Switches that stop the flow of electricity Child Resuscitation in any electrical emergency. Many older Background homes have upgraded their power Baby Resuscitation installation with RCDs to make it safer The first aider must consider the safety of the victim, Special Resuscitation self and any bystanders before attempting to rescue for family members. Larger premises such and assist a sick or injured person. There are many as offices or factories are required by law CPR Chart situations in which great care must be taken because to have similar safety devices installed of the presence of a specific hazard, such as high- for the protection of employees. Abdominal Injuries voltage electricity cables, fire, toxic fumes or road traffic. Asthma High-voltage electricity The electricity supply that is seen in the street Allergic Reaction Electricity and which runs between power poles is both low and high-voltage. High-voltage power may Bites and Stings Domestic electricity be found at major factories and workshops. If Bleeding Although the domestic electricity supply is low-voltage, a high-voltage power cable is brought down in accidental contact with a live conductor can cause an accident, it is very dangerous for anyone in Burns and Scalds serious injury or death. A characteristic injury is seen the area. High-voltage electricity can travel up as an entry burn at the point of contact, plus a more to 8 metres from the cable, and possibly Chest Injuries extensive exit burn where the electricity went to “earth”. further in damp or wet conditions. Therefore, as bystanders do not know the voltage Childbirth/Miscarriage The first aider must remember to make the area safe concerned, they must remain more than 8 before attempting to touch or rescue the victim. The metres from the power cable: no first aid or Choking source of electricity must be identified and contact emergency care can be given until the electricity broken in the easiest but safest manner. If it is possible supply authority has declared the area safe. Cold Illness to remove an appliance plug from the power supply point, then this will stop the flow of electricity. It is Convulsions/Seizures quite inadequate to rely on the power point switch because it is still possible for electricity to flow even Croup after the power point switch has been turned off. Diabetes Alternatively, the power should be turned off at the mains supply board to ensure safety for all concerned. Drug/Alcohol Overdose 8 metres Eye Injuries Fractures/Dislocations An accident victim cannot be rescued from an Head Injuries area that has been energised by high-voltage power but the first aider should shout advice Heart Conditions and warn the victim against any attempt to move or leave the area. If the victim has survived Heat Illness the initial accident, their survival may depend on staying in one place until a safe rescue can be Hyperventilation carried out after the power has been disconnected. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED When a safe rescue is possible, the first aider If a driver is trapped in a car with a high- should check the victim following the Basic Life voltage cable in contact with the vehicle, the Poisoning Support Flow Chart and be prepared to give CPR victim is safe as long as there is no attempt to Shock/Fainting if necessary — see Resuscitation. leave the car. Again, advice can be shouted to the conscious victim and reassurances given If the victim does not need CPR, the first aider that the emergency services have been called Spinal Injuries should check for any burns, looking carefully for and are due to arrive at any moment. For the exit burn that is likely to be the most serious example, if the conscious victim has a bleeding Sprains/Strains/Bruises injury. First aid treatment is needed to protect any wound, shouted advice can be given to apply Stroke wound and reduce further damage — see Burns. pressure with elevation and rest. Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 92 SKILLS AND PROCEDURES Adult Resuscitation Water Adult Defibrillation After rescuing a person from water it is important If a person has fallen into water and is either to wrap the victim’s head, neck, trunk and limbs Child Resuscitation unconscious, or unable to swim, the rescuer needs in a warm blanket to maintain body heat and avoid to take great care to avoid personal injury, especially the onset of hypothermia — see Cold illness. Baby Resuscitation if not a good swimmer. Unless the rescuer is an excellent swimmer, no attempt should be made Any person who has been rescued from water Special Resuscitation to rescue a victim from deep water. should have a medical assessment as soon as possible, even if there are no symptoms and When attempting to rescue a person from water, CPR Chart signs of illness resulting from the immersion. use a rope, flotation device, tree branch or large Late complications are common after an Abdominal Injuries towel to avoid having direct contact with the immersion incident and a young child is conscious victim. It is best to stay on firm ground particularly vulnerable. Asthma and to avoid entering the water, which may add to the risks of the rescue. Road accidents Allergic Reaction Whether a driver, passenger or pedestrian, Bites and Stings the victim of a road accident is often seriously injured and in need of urgent medical Bleeding assessment and treatment. The first aider might be the first person on the scene and may be Burns and Scalds influential in saving a life before the arrival of Chest Injuries ambulance personnel. Anyone involved in the accident might also need support although Childbirth/Miscarriage there may be no obvious injuries. The driver of a car that has hit a pedestrian or cyclist will be Choking most distressed and may even suffer a heart attack from the severe stress. Cold Illness Convulsions/Seizures Croup Diabetes Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries Motor vehicle accident victims Whatever the circumstances, the first aider must Heart Conditions The unconscious victim in shallow water should be ensure safety for self, victim and bystanders. Heat Illness assessed as soon as possible and, if there is no normal This may involve obtaining help to make the breathing, rescue breathing should be started area safe before approaching the victim, or Hyperventilation immediately — see, Resuscitation in water. simply asking a bystander to use hazard lights If the victim needs resuscitation, an immediate to warn oncoming traffic of the emergency Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED retrieval from the water is vital because it is impossible scene ahead. to give effective CPR in the water — see Resuscitation. On reaching a vehicle at an emergency scene, Poisoning Many water rescues may be for the victim of a the first aider should: Shock/Fainting potential spinal injury, e.g. resulting from jumping • check that the ignition key is turned off and off a jetty into shallow water or striking a do this if necessary Spinal Injuries submerged object in a river. If a spinal injury is a • put the vehicle in gear and with the possibility the victim should be supported in the handbrake on for safety Sprains/Strains/Bruises water and towed by the head until a rescue team • warn bystanders not to light a cigarette in Stroke is available — see Spinal injuries. case there is any leaking fuel. Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 93 SKILLS AND PROCEDURES Adult Resuscitation Road accidents cont. Adult Defibrillation

There are serious risks in trying to assess and treat Child Resuscitation an accident victim on a roadway or where there is traffic. If the victim is lying on the road or in a Baby Resuscitation position of danger from oncoming traffic, use one of the dragging methods to reach a safer location Special Resuscitation — see Moving a sick or injured victim. CPR Chart Unless the victim appears to be uninjured, ensure that a bystander makes a prompt call to 000 or Abdominal Injuries mobile 112 for an ambulance. The helmet may still provide protection to the Asthma If unconscious, turn the victim onto the side victim’s head and the first aider must assess the immediately and be prepared to commence CPR if need to remove it. If the victim is breathing with a Allergic Reaction necessary — see Resuscitation. clear airway, it may be possible to leave the If there are any bleeding wounds, apply prompt helmet in place until the arrival of the ambulance. Bites and Stings pressure and elevation while assessing any other If the victim is not breathing normally it is Bleeding injuries — see Bleeding. essential to remove the helmet to allow rescue When a person appears to have extensive injuries breathing and CPR to be given. Burns and Scalds and is still seated in a vehicle, it is best to avoid movement of any nature unless it is essential for the Removal of the helmet Chest Injuries victim’s wellbeing. For example, when a person becomes unconscious it is advisable to remove To remove the helmet it is best to have two Childbirth/Miscarriage the victim from the vehicle to ensure adequate people available, one to steady the head and protection of the airway. neck and the other to gently remove the helmet. Choking If a person is trapped in a seat by extensive damage to Cold Illness the vehicle, assess and manage the victim as outlined for any trapped person — see Trapped victims. Convulsions/Seizures Croup Motorcycle accident victims A person who is involved in a motorcycle accident Diabetes may receive multiple injuries and may have a potential spinal injury from hitting the road head first. Drug/Alcohol Overdose The first step is to ensure safety for the first aider, Eye Injuries victim and any bystanders. Unless the area is safe However, if there are no bystanders the first aider Fractures/Dislocations from traffic hazards, the victim must be moved must carry out the manoeuvre without help as promptly by one of the dragging methods — see follows: Moving a sick or injured victim. Head Injuries • The sides of the helmet must be pulled Once in a safer area a full assessment and first outwards to loosen the moulded grip over the Heart Conditions aid treatment should be carried out following the ears. Basic Life Support Flow Chart. All other first aid Heat Illness should be given as outlined on the relevant pages • While keeping the two sides apart, the helmet of this handbook. should be tilted upwards to free the point of Hyperventilation the chin, avoiding any movement of the head If the victim is unconscious it may be necessary and neck. Mouth/Tooth Injuries to remove the rider’s helmet to gain access to the UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED • The helmet is tilted forwards to lift it over airway. Initially, if there is no response, the victim Poisoning should be rolled onto the side for airway care. If the back of the head and off the face, again a detachable visor is present, it should be quickly without undue movement of the head and Shock/Fainting removed to permit access to the mouth and nose neck. area. If a chin strap is present it should be undone If the victim is conscious the first aider must Spinal Injuries or cut through to allow access to the mouth and be guided by the rider’s wishes and assist if lower jaw. necessary in removal of the helmet. If the victim Sprains/Strains/Bruises is nauseated or likely to vomit the helmet should be removed at an early stage. Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 94 SKILLS AND PROCEDURES Adult Resuscitation Chemicals Fire or toxic fumes Adult Defibrillation Chemical spills may occur in certain workplaces When fire complicates an emergency, the first aider or on the road following a tanker collision should be conscious of the danger and the serious Child Resuscitation or rollover. If there is a Hazchem sign on the risks of going into a burning room or building. tanker, quote the Hazchem code when calling Home fires are associated with the release of toxic Baby Resuscitation for assistance. As a general rule the first aider fumes from furniture made of synthetic products. should stay well clear of any chemical and, in Entry into a place where there is dense smoke or Special Resuscitation the workplace, trained safety personnel should toxic fumes is most unwise and may result in the CPR Chart deal with the hazard quickly and effectively loss of another life. Fire officers will generally use according to standard operating procedures. breathing apparatus to give protection from smoke Abdominal Injuries Where chemicals are used there should be a or fumes and the first aider should make sure that Material Safety Data Sheet (MSDS) for each one the emergency services have been called and wait Asthma and all workers in that area should be familiar for such trained assistance to arrive. Allergic Reaction with it. If an ambulance is required after a If caught in a smoke-filled area, the first aider chemical injury the ambulance crew members should drop to the floor and attempt to crawl to Bites and Stings should be given a copy of the MSDS. safety. If a victim has collapsed in the area, use one When giving first aid treatment to the victim of of the dragging techniques for the rescue — see Bleeding chemical burns the first aider should be careful Moving a sick or injured victim. to avoid contamination from the victim’s skin or If smoke or toxic fumes overcome the victim, make Burns and Scalds clothes. If there is a water shower unit nearby, the a rapid assessment of the victim and be prepared Chest Injuries victim should be showered fully clothed and to carry out CPR if necessary — see Resuscitation. contaminated items removed under the protection If the victim has inhaled any smoke or toxic fumes, Childbirth/Miscarriage of running water to dilute the chemical. the mouth, throat and lower airways may have been With the exception of hydrofluoric acid, no attempt burned. Look for signs of burning, e.g. singed hairs Choking should be made to use a specific neutralising inside the nose or a hoarse voice — see Burns. Cold Illness solution for acid or alkali burns because it may Sometimes a victim may be found with clothing well cause further tissue damage. A chemical on fire. The immediate response should be to get Convulsions/Seizures burn should be flushed with running cold water the victim to floor level and wrapped in a cotton for up to 30 minutes. The treatment may be or wool blanket to extinguish the flames. The Croup continued until the arrival of an ambulance. best advice to follow is to Stop, Drop and Roll to For a hydrofluoric acid burn, calcium gluconate extinguish the flames and avoid any further injury. Diabetes gel should be readily available as a neutralising agent wherever this chemical is used. The gel Drug/Alcohol Overdose should be applied as soon as possible either by the victim or the first aider wearing heavy-duty Eye Injuries industrial gloves — see Burns. Fractures/Dislocations If the chemical is in powder or crystal form, e.g. powdered chlorine, wear heavy-duty industrial Head Injuries gloves to brush any particles off the skin before using cool, running water to neutralise the Heart Conditions remaining chemical. Phosphorus is especially dangerous and may suddenly ignite. To avoid Heat Illness this additional hazard, the first aider should try Hyperventilation to keep the area wet and pick off any visible particles under water using a pair of forceps Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

rather than gloved fingers — see Burns. Poisoning Once the flames have gone out, quickly check the Shock/Fainting victim for any burns and give appropriate treatment — see Burns. Spinal Injuries Ensure prompt medical assessment to avoid serious Sprains/Strains/Bruises complications occurring later. Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 95 SKILLS AND PROCEDURES Adult Resuscitation Emergency procedures Adult Defibrillation Child Resuscitation Moving a sick or injured victim Arm Drag Method Baby Resuscitation The first aider should use this method when there As a general rule it is important to avoid moving are obvious lower limb injuries. any sick or injured victim because of the risks of Special Resuscitation causing complications to the underlying condition. Crouching low, the first aider should pull the Obvious exceptions to this rule include turning victim’s arms above the head and grip the elbows CPR Chart if possible. The elbows should be held in firmly an unconscious person onto the side for airway Abdominal Injuries management, or moving a person from life- against the victim’s head to give support and prevent the head from dragging on the ground threatening danger to a safer location, e.g. from Asthma the middle of traffic to the roadside. during the move. A first aider is wise to avoid lifting a person off the Allergic Reaction ground, even with bystander assistance, because such an action is likely to move bones and muscles Bites and Stings out of their current alignment. The safer alternative Bleeding is to drag the victim in the long axis of the body, using either the arms or the legs for traction, thus Burns and Scalds maintaining body alignment. The only safe lift for first aid is the Blanket Lift for which a minimum of Chest Injuries six people and preparation time are needed. Childbirth/Miscarriage If it is impossible to hold the arms against the The safest first aid methods of moving a victim head, a wrist grip should be used. Again the first Choking are as follows. aider should crouch low and grip both wrists firmly, leaning back to use body weight to drag Cold Illness the victim to safety. Leg Drag Method Convulsions/Seizures This is the preferred method where there are no obvious lower limb injuries. Clothing Drag Method Croup If the victim has multiple injuries, it may be best to Crouching low, the first aider grips the victim’s Diabetes ankles firmly and, leaning back, allows body weight use clothing for the drag to avoid direct traction on to drag the victim to safety. the body. However, there are additional risks with Drug/Alcohol Overdose this method because clothing may suddenly tear and create a whiplash effect on the victim. Where Eye Injuries possible it is always best to use one of the body contact methods outlined above to reduce the risks Fractures/Dislocations of moving the victim. To use the clothing drag the first aider needs to Head Injuries have a firm grip on clothing that is pulled up Heart Conditions firmly under the armpits. A coat or jacket will be better than a woollen sweater, which may not Heat Illness take the victim’s body weight. The first aider then crouches down low and leans back while pulling Hyperventilation firmly on the clothing. Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 96 SKILLS AND PROCEDURES Adult Resuscitation Blanket Lift This method is safe only when there is a minimum Adult Defibrillation of six bystanders present, plus a strong blanket long Child Resuscitation enough to support the victim’s entire body. It is not a suitable method for an emergency when Baby Resuscitation life-threatening danger is present, but it may be useful in a remote area where there is likely to be Special Resuscitation a significant delay before the arrival of trained personnel. In this situation it is designed to assist CPR Chart in the transfer of a sick or injured person out of extreme weather conditions. Abdominal Injuries First the blanket must be rolled up along its Asthma length until only half of the blanket is left flat on the ground. The rolled edge is then placed along Allergic Reaction the victim’s side, making sure that the blanket will support both the feet and head. Bites and Stings When the most highly trained person present Next the three helpers on the opposite side roll is satisfied that the lift will be safe, the lifters Bleeding the victim onto their knees using a “log-roll” are told to lean outwards slightly to keep the technique in which the victim’s head, neck, blanket tightly stretched and the order is given Burns and Scalds spine, hips and legs are kept in a straight line to “lift slowly”. throughout. The rolled edge of the blanket is then Chest Injuries placed close to the victim’s spine and the victim gently eased back onto the ground. Childbirth/Miscarriage Choking Cold Illness Convulsions/Seizures Croup Diabetes Drug/Alcohol Overdose Eye Injuries Fractures/Dislocations Head Injuries The victim is then “log-rolled” flat to allow the Heart Conditions blanket roll to be pulled out, leaving the victim lying centrally on the blanket. Three helpers The lifters then face forwards and walk slowly Heat Illness should stand on each side and roll up their side to the planned location. It is vital that the lifters of the blanket into a tight roll held close to the Hyperventilation are told to avoid walking “in step” because this victim’s body. The first person on each side should would cause the victim to rock from side to side. grip the blanket roll with one hand close to the Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Once the new location has been reached, the victim’s ears and the other at shoulder level. order is given to lower the victim, slowly and Poisoning The middle person on each side should grasp the carefully. blanket roll at mid-chest level and close to the Shock/Fainting victim’s hips. The third person on each side should grasp the blanket roll with one hand close to the Spinal Injuries victim’s thighs and the lower hand close to the victim’s feet. Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 97 SKILLS AND PROCEDURES Adult Resuscitation Trapped victims Care of a victim in a remote area Adult Defibrillation There are situations where a victim may be trapped An emergency in a remote or isolated area and requires rescue by emergency personnel with presents a special challenge to the first aider, Child Resuscitation special training and equipment. For example: although it is rare for the individuals involved • a person trapped in a car needing a rescue team to be without either a satellite phone or access Baby Resuscitation with the “Jaws of Life” cutting equipment to the Royal Flying Doctor Service (RFDS). When people are working in remote areas, e.g. mining Special Resuscitation • a person in a workplace who is trapped in a engineers or surveyors, detailed plans and confined space and needs rescue by an individual guidelines are generally available for managing CPR Chart who holds a “Confined Space Entry Permit”. any emergency. Such plans include: There are several actions that a first aider can Abdominal Injuries • communication strategies to notify the nearest take to maintain life until a full rescue can take assistance (it is customary for an employer to Asthma place. The first aider should try to carry out the have arranged RFDS cover in advance) standard assessment and management techniques Allergic Reaction outlined earlier in this handbook. The following are • provision of a RFDS medical kit, which contains a examples of a modified approach. wide range of medications and first aid equipment. Bites and Stings All that is required in an emergency is telephone Bleeding Unconscious victim contact with the nearest RFDS base station. If unconscious, try to clear and open the victim’s Radio link Burns and Scalds airway in the position found. If in a motor vehicle where the victim is held in a vertical position by a If the RFDS radio link is used, there will be ongoing Chest Injuries seat belt, leave the seat belt in place to stabilise the advice and feedback from that service and the victim. Support the head while the airway is cleared first aider will not feel so isolated. There may be a Childbirth/Miscarriage temptation to drive the sick or injured person out and opened using head tilt and chin lift to support Choking the jaw . Either support the head from behind, or of the area in an attempt to get help as soon as through the side window if this is easier. possible. It is rarely wise to undertake such an Cold Illness evacuation because of the real risks of further complications occurring during transport. Most Convulsions/Seizures victims are best left in one place until help arrives. If there is no radio or telephone contact from the Croup emergency scene, it is best to identify a person who is available to drive to the nearest town or Diabetes village and arrange for a rescue team to arrive. Drug/Alcohol Overdose However, each situation must be judged on its merits and it is rarely wise for one of only two Eye Injuries people to leave the emergency scene to fetch help unless no other arrangements are possible. Fractures/Dislocations The first aider may need help with adjusting the Victim not breathing victim’s position and if resuscitation is suddenly Head Injuries If not breathing normally, it may be possible to give needed, a second person can be invaluable. rescue breathing if the first aider is able to seal Heart Conditions the victim’s mouth and nose from any achievable Longer term care Heat Illness position. It is not possible to give effective CPR The main difficulty faced by a first aider in a remote unless the victim is lying flat on a firm surface. or isolated area is the likely time delay before the Hyperventilation arrival of highly trained help. It often becomes Bleeding victim necessary for the first aider to maintain care of Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

If the victim is bleeding and it is impossible to the victim for several hours before help arrives. Poisoning secure a dressing in place with a bandage, the first The following aspects of care are additional to the aider should hold the pad in place with firm hand specific first aid treatments outlined in this handbook. Shock/Fainting pressure until trained assistance is available. Unconscious victim Spinal Injuries If the victim is unconscious, positioning is as for any other unconscious person. The first aider Sprains/Strains/Bruises should begin CPR promptly if normal breathing stops — see Resuscitation. Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 98 SKILLS AND PROCEDURES Adult Resuscitation Conscious victim Measure fluid output • Make the victim comfortable. Assist with the elimination of urine or faeces, Adult Defibrillation although the latter is unlikely in the presence of • Position the victim carefully to avoid unnecessary severe illness or injury. If urine is passed it should Child Resuscitation movement that may cause further complications. be collected into a suitable container, preferably The victim can choose the position of greatest Baby Resuscitation glass or plastic, with a lid that can be secured. comfort and the first aider should then It is important to measure any urine passed to provide clothing or bedding materials to take Special Resuscitation ensure that a similar replacement volume is the pressure off the bony parts of the body. given. Keep any urine in case the rescue team Depending on the position adopted by the CPR Chart needs to test it to assist with an early diagnosis. victim, this may include the back of the head, For example, the presence of any blood or dark Abdominal Injuries shoulders, elbows, buttocks and heels. discolouration may be a guide to the degree of Shelter the victim internal injury. Asthma If it is necessary to move the victim into a Assess and record the vital signs Allergic Reaction sheltered area to avoid extremes of heat or cold, Assess and record the victim’s vital signs at do this promptly and carefully, provided that Bites and Stings frequent intervals and at least every 15 minutes the move will not cause additional pain or injury — see Vital signs. to the victim. The surface on which the victim Bleeding will rest may need to be protected by insulated Burns and Scalds material plus a blanket for additional comfort. It may be necessary to provide an additional blanket Chest Injuries on top to maintain body heat, or items of clothing may be used. Childbirth/Miscarriage Change victim’s position Choking Consider changing the victim’s position if there is likely to be a delay of two or more hours before Cold Illness a retrieval team arrives. Pressure must be taken Convulsions/Seizures off the main contact points of the body, which may be achieved by simply allowing the victim to turn Croup from the back to the side or from one side to the other. Much will depend on the underlying illness Diabetes or injury and care must be taken to avoid any unnecessary risks caused by moving the victim Drug/Alcohol Overdose from one position to another. Eye Injuries Maintaining a safe fluid balance Fractures/Dislocations Maintain an adequate circulation through the provision of fluids if there is to be a significant delay before Head Injuries the arrival of a rescue team. Note that the first aid care of most injuries will include a strong warning Heart Conditions about giving any food or fluids because of safety risks if an anaesthetic or surgical procedure is The first aider should also: Heat Illness needed. In hot or remote conditions this caution • record any additional symptoms or signs that must be balanced against the risk of dehydration. may occur during the hours following onset of Hyperventilation the problem The victim should be offered frequent small sips of Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED cool fluids because the condition of shock will make • ask the victim if there are any changes in it difficult for a victim to absorb any larger volume sensation that should be noted Poisoning of fluids. Avoid hot fluids because they will cause • check any dressings, bandages or splints on a rapid increase in circulation to the stomach, which Shock/Fainting each occasion to ensure that wounds are still will divert blood from other areas of the body. covered, bleeding controlled and bandages firm Spinal Injuries Measure and record all fluids given so that the total but not too tight. amount can be advised to the retrieval team. This Sprains/Strains/Bruises will be easier if a known amount of fluid is poured into a small container from which sips can be given, Stroke e.g. a cup or mug, which generally holds 250ml. Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 99 SKILLS AND PROCEDURES Adult Resuscitation Multiple victims Adult Defibrillation Sometimes the first aider is faced with the Less serious conditions must wait for treatment need to assess and treat more than one victim. until all the above priorities have been met. Child Resuscitation Although bystanders may be available to assist, It is important to reassess all individuals on a Baby Resuscitation the first aider will need to: regular basis to note any changes that might • check whether any of them have current first have occurred, especially where there is any Special Resuscitation aid training deterioration since the previous check. • supervise any first aid that is being given in The assessment and management of the above CPR Chart case the victim’s condition is made worse. conditions are found under the A – Z Index of topics in this handbook. Abdominal Injuries Setting emergency care priorities Asthma After the emergency Triage is the method used to sort sick and injured Allergic Reaction victims into priorities according to their first When trained help has arrived and the victim is aid needs. This method follows the standard being treated professionally, the first aider may Bites and Stings priorities of the Basic Life Support Flow Chart. feel a little lost. During the emergency, a flow of Any person suffering from airway or breathing adrenaline allows the first aider to move quickly Bleeding problems must take priority over the care of and remain detached from everyday concerns. Once a person with a less serious condition, e.g. a trained personnel accept responsibility for care of Burns and Scalds the victim, the adrenaline flow returns to normal. distressed victim with a crushed foot who is Chest Injuries shouting out with pain. Suddenly the first aider may feel a sense of tiredness with various aches and pains, especially Childbirth/Miscarriage 1. Top priority is always given to: if CPR was given. The first aider also may feel: • Airway obstruction possibly resulting from • confused about what to do next when the Choking severe facial injuries, airway burns etc victim has been taken to hospital. Cold Illness • Breathing difficulties possibly resulting from • a sense of satisfaction if the victim is alive as a chest injury or the inhalation of smoke or result of the first aid given. Convulsions/Seizures fumes • anxious, depressed or even tearful, especially • Circulation problems associated with chest if the victim is seriously injured or has suffered a Croup pain, severe blood loss or circulatory collapse massive heart attack. Diabetes due to severe shock • an awareness that something was overlooked • Major burn or scald injury, especially where or a treatment left undone, causing a sense of Drug/Alcohol Overdose more than 20% of the body is involved. personal failure. Eye Injuries • Major injuries of the head, chest or abdomen • anger or frustration that first aid is suddenly no • Uncontrolled bleeding longer needed. Fractures/Dislocations • Unconsciousness Head Injuries Coping mechanisms for stress 2. Second priority is given to: The first aider may recognise signs of personal Heart Conditions • Burn or scald injury involving less than 20% of stress including irritability, flashbacks, disturbed the body surface sleep or a feeling of withdrawal from family, friends Heat Illness • Closed abdominal injury, e.g. abdominal pain and work colleagues. If the first aider regularly Hyperventilation without any wound practises yoga or meditation, then these may be • Closed head injury, e.g. concussion or altered used to reduce stress levels and allow the first aider Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED to refocus on everyday life. If the symptoms of stress level of consciousness do not go away in a matter of hours or overnight, Poisoning • Open fracture, e.g. where there is a wound the first aider should seek medical advice. When over the bony injury the victim is a close colleague or family member, or Shock/Fainting when a group of personnel provide a team 3. Third priority is given to: response to a workplace emergency, it is important Spinal Injuries • A major fracture to have a debriefing or evaluation session guided Sprains/Strains/Bruises • Eye injury by a health professional. Post-traumatic stress affects people in different ways and sometimes • Hand injury ongoing professional help is needed. Stroke • Spinal cord injury Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 100 SKILLS AND PROCEDURES Adult Resuscitation Infection control in first aid Adult Defibrillation Child Resuscitation When giving first aid to a sick or injured person Rules for wound care you should try to minimise the risks to yourself, Baby Resuscitation the victim and any helpers or bystanders. Wash your hands and always apply disposable latex or nitrile gloves unless life-threatening Special Resuscitation bleeding is present — see Bleeding. Ten basic rules for first aid A wound containing dirt or other contaminants CPR Chart 1 When possible, wash your hands with soap and should be cleaned with either an antiseptic Abdominal Injuries water and apply disposable latex gloves before solution or soap and water. touching a wound, blood or other body fluids. Asthma 2 In the case of serious bleeding, where there is no time to obtain or apply gloves, it is possible to Allergic Reaction control the blood loss without having any direct contact with blood — see Bleeding. Bites and Stings 3 If you have any cuts or wounds on your Bleeding hands, ensure that they are fully covered by a waterproof dressing before applying gloves. The wound should be dried thoroughly before Burns and Scalds the dressing is applied. 4 Keep your face turned away during any Chest Injuries treatment to avoid inhaling droplets of a Avoid direct finger or hand contact with potentially serious infection, e.g. tuberculosis. the wound or the central part of the sterile Childbirth/Miscarriage dressing. 5 If you are splashed with blood or other body Choking fluids, wash the area thoroughly with soap and Apply a light dressing to the wound and secure it with a bandage or tape. water as soon as possible. Then contact your Cold Illness doctor for specific medical advice. 6 If any of your clothing has been contaminated Convulsions/Seizures by body fluids, remove it promptly and immerse Croup it in a container of laundry soaker, mixed according to and following the instructions on Diabetes the label. 7 Safely dispose of any used dressings, bandages Drug/Alcohol Overdose and disposable gloves into a plastic or paper If the dressing is accidentally dropped or slips bag, sealing it well before putting it into a off the wound, apply a fresh one at once. Eye Injuries rubbish bin with a well-fitting lid. If the wound has any obvious discharge Fractures/Dislocations 8 If there is a hospital or medical clinic nearby, present, use an absorbent dressing on top the dressings can be disposed of into a medical of the first sterile dressing and bandage it in Head Injuries Hazardous Waste bin where they will be treated place firmly. correctly and incinerated. After securing the wound dressing, remove your Heart Conditions gloves and wrap them with any soiled dressings 9 Used instruments, such as scissors or splinter Heat Illness and put them in a plastic or paper bag. The bag forceps, should be cleaned thoroughly under should be placed in a covered disposal bin or in running cold or warm water. Serrated edges Hyperventilation a Hazardous Waste container. should be scrubbed with a fine nailbrush under running water. The articles should then be Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

disinfected by an approved method. Preferably Poisoning by immersion for two minutes in 70% Alcoholic Chlorhexidine or 30 minutes in a 1:80 bleach Shock/Fainting solution. 10 After removing disposable gloves always wash Spinal Injuries your hands thoroughly with soap and water. Dry Sprains/Strains/Bruises your hands well to avoid cracking of the skin. Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 101 SKILLS AND PROCEDURES Adult Resuscitation Dressings and bandages Adult Defibrillation A dressing is used to protect a wound and Child Resuscitation prevent infection, but also to allow healing to occur underneath the dressing. A dressing should Baby Resuscitation be large enough to totally cover the wound, with a safety margin of about 2.5cm on all sides Special Resuscitation beyond the wound. A sterile dressing may be CPR Chart used to control bleeding from a major wound or to absorb any discharge from a minor wound. Abdominal Injuries Dressings vary greatly in nature and size, so it is important to select the correct dressing for use on Asthma a specific wound. Sterile non-adherent dressings Allergic Reaction A bandage is used in combination with a dressing Very light dressings are used to aid healing on where a wound is present. A roller bandage is a minor wound and most have a non-adherent Bites and Stings used to secure a dressing in place or to slow the surface. A non-adherent dressing is often covered absorption of venom into the body after a snake on one or both sides with a plastic film containing Bleeding or spider bite. A triangular bandage is used as many perforations. If only one side has a plastic an arm sling or as a pad to control bleeding. It film, that is the side to be placed against the Burns and Scalds may be used to support or immobilise an injury wound. This allows fluids to pass through into an to a bone or joint or as improvised padding over a absorbent layer, to keep the wound dry. Chest Injuries painful injury. A tubular gauze bandage is used to Other types of non-adherent dressing have a Childbirth/Miscarriage retain a dressing on a finger or toe. special synthetic coating on one or both sides to prevent adhesion to the wound surface. The Choking non-adherent layer is always placed against the wound. To reduce confusion and incorrect use, Cold Illness some manufacturers make both sides non-adherent. Convulsions/Seizures Non-adherent dressings are used for extensive surface wounds such as an abrasion (graze) or Croup burn — see Bleeding and Burns. For a major burn or scald, a special burn dressing Diabetes Dressings known as “tulle gras”, which is an open weave dressing coated with sterile jelly, may be used. Drug/Alcohol Overdose These have the advantage of staying moist for Sterile wound dressings Eye Injuries Wound dressings will be in a sterile packet, which 24 to 48 hours, which can reduce pain from the should be opened carefully by a person with clean injury and are easier to remove and change. Fractures/Dislocations or gloved hands. Then, to avoid contamination of the sterile dressing, it is not removed from the opened Adhesive strip dressings Head Injuries packet until the wound is ready to be covered. An adhesive strip dressing may protect minor Heart Conditions Dressings used to control bleeding must be bulky wounds and some are especially shaped for the to ensure that adequate pressure is applied over knuckle, heel, finger tip etc. An adhesive dressing Heat Illness the injured area. The most common dressing is should not be left in place for more than 24 made of combined wool or cellulose, covered in a hours without being removed to allow the wound Hyperventilation light cotton woven fabric and they are generally to dry. If necessary, a fresh adhesive dressing may known as “Combine Dressings”. be used if the wound is not fully healed or where Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED protection from clothing is needed. A plastic Some major wound dressings are labelled adhesive dressing should be used only for short Poisoning as BPC (because they are listed in the British periods of time to protect against moisture or Pharmacopeia) and consist of a sterile combine grease. If not replaced every day with a porous Shock/Fainting dressing with attached bandage. They are ideal to fabric dressing, the wound may break down, fill crater wounds or to control severe bleeding taking longer to heal or becoming infected. Spinal Injuries — see Bleeding. A special adhesive dressing coloured blue is used Sprains/Strains/Bruises Sterile gauze squares are used mainly for cleaning by cooking and catering personnel because it is a wound because of loose cotton fibres that X-Ray detectable and easily found when food Stroke might stick to the wound during healing. items are scanned. Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 102 SKILLS AND PROCEDURES Adult Resuscitation Applying roller bandages Adult Defibrillation A roller bandage needs to be chosen carefully to Child Resuscitation ensure that it is the correct width for the body part involved. As a general guide, the following Baby Resuscitation widths are recommended: • Lower arm, elbow, hand and foot – 75mm Special Resuscitation • Upper arm, knee and lower leg – 100mm CPR Chart • Large leg or trunk – 150mm It is best to use a bandage with some degree of Abdominal Injuries Improvised dressings stretch in the weave. This will make the bandage Asthma In an emergency a dressing may be improvised easy to use and more likely to stay in place for from a range of materials. To control bleeding a many hours. However, the correct application Allergic Reaction bulky pad may be made from a bundle of several technique is essential to provide comfort and facial tissues or from any clean, non-fluffy material. adequate support for the affected part. Bites and Stings For a minor burn or scald, a piece of clean plastic Bleeding kitchen film may be used initially. However, if the Basic steps to successful use of a roller burn is serious, it is vital to use only sterile coverings bandage Burns and Scalds to avoid the risk of infection. Cooling should be • Bandage the part in the position of greatest continued until a sterile dressing is available comfort to the victim. Support the part Chest Injuries — see Burns. adequately before starting to apply the Childbirth/Miscarriage bandage. Bandages • Hold the tightly rolled bandage with the Choking “head” of the bandage on top and wrap the Roller bandages vary greatly depending on how “tail” around the body part without unrolling Cold Illness they are to be used. more than a few centimetres at a time. Convulsions/Seizures A roller bandage is used to: • Begin with a locking turn to hold the start of • hold a dressing in place on a wound the bandage securely under each following Croup • maintain pressure over a bulky pad to control turn. bleeding • Work from the middle of the body or limb in Diabetes an outwards direction. • support an injured limb or joint Drug/Alcohol Overdose • Work from the narrowest part below the • apply pressure to a limb after a venomous bite. dressing and work upwards. Eye Injuries Roller bandages are made from lightweight • Ensure that each turn covers two-thirds of the cotton, crepe or elasticised crepe, depending on previous turn. Fractures/Dislocations the pressure to be achieved. A lightweight cotton • Cover totally any dressing and padding used. bandage is used to hold a dressing in place, whereas Head Injuries a crepe or elasticised crepe bandage is used for • Finish with a straight turn at the end of the Heart Conditions the Pressure Immobilisation Bandaging Technique bandage. following a snake or Funnel Web spider bite — see • Secure the bandage with a safety pin or Heat Illness Bites and stings. adhesive tape. Avoid the use of metal clips because they are less secure and can fall out Hyperventilation during activity. • After finishing the bandage, check the Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED circulation in the fingers or toes. Compare Poisoning both arms or both legs to detect any change in colour that would indicate the bandage is too Shock/Fainting tight. If the tissues on the affected side appear blue-tinged or white, or if the victim complains Spinal Injuries of any numbness or tingling, loosen the bandage immediately and re-check the part Sprains/Strains/Bruises frequently until a normal colour is achieved. Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 103 SKILLS AND PROCEDURES Adult Resuscitation Applying a roller bandage to the lower • Make a second turn just below the first, arm or leg exposing one-third of the initial turn over the Adult Defibrillation • Apply a dressing or padding over the affected point of the elbow or knee. Child Resuscitation area. • Start with a diagonal, locking turn below the Baby Resuscitation dressing or padding to secure the dressing. Special Resuscitation CPR Chart Abdominal Injuries Asthma Allergic Reaction Bites and Stings Bleeding • Continue up the limb, covering two-thirds of each previous turn. Burns and Scalds • Finish with a straight turn to secure the bandage Chest Injuries and fasten it with a pin or adhesive tape. • Make a third turn just above the first, again Childbirth/Miscarriage exposing one-third of the initial turn over the point of the elbow or knee. Choking • Continue with one or two more turns alternately working from below to above the Cold Illness affected joint, until the dressing or padding is fully covered. Convulsions/Seizures Avoid any extra turns that will cause pressure on Croup the inside surface of the joint. • Finish with a full turn above the elbow or knee Diabetes and secure the bandage with a safety pin or Applying a roller bandage to the adhesive tape. Drug/Alcohol Overdose elbow or knee Eye Injuries • Apply a dressing or padding over the affected area. Fractures/Dislocations • Start with a full turn over the point of the Head Injuries elbow or knee to secure the bandage. Heart Conditions Heat Illness Hyperventilation Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Poisoning Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 104 SKILLS AND PROCEDURES Adult Resuscitation Applying a roller bandage to the Applying a triangular bandage Adult Defibrillation hand or foot Triangular bandages are usually made from a • Apply a dressing or padding over the affected metre square of cotton or calico that is cut in Child Resuscitation area. half diagonally. The bandage can be used in Baby Resuscitation • Start with a diagonal, locking turn around the various ways as a sling or for immobilisation of broken bones and soft tissue injuries. wrist or foot. Special Resuscitation • Carry the bandage across the back of the hand to the base of the little finger or little toe and then Sling CPR Chart make a complete turn around the fingers or toes. • In the open form as a sling to support an upper body injury. Abdominal Injuries Asthma Allergic Reaction Bites and Stings Bleeding Burns and Scalds Chest Injuries Broad-fold bandage • As a broad-fold bandage with the apex folded Childbirth/Miscarriage down to the base twice to immobilise a lower body injury. Choking Cold Illness Convulsions/Seizures • Make another turn across the back of the hand or foot from the fingers/toes to the wrist/ankle. Croup • Repeat these turns working upwards with each Diabetes turn until the dressing or padding is covered. Narrow-fold bandage • Finish with a circular turn around the wrist/ankle • As a narrow-fold bandage with the broad- Drug/Alcohol Overdose and secure the bandage with a safety pin or fold bandage folded in half to control severe adhesive tape. bleeding, or for immobilisation of a lower Eye Injuries limb. Fractures/Dislocations • As a collar-and-cuff sling for an upper body injury. Head Injuries Heart Conditions Heat Illness Pad Hyperventilation • As a folded pad after the ends of the narrow- Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED fold bandage have been brought into the

centre three times, and for use on a major Poisoning wound or as padding when immobilising bandages are applied. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 105 SKILLS AND PROCEDURES Adult Resuscitation Tying a reef knot with a triangular Arm sling Adult Defibrillation bandage This sling is used to support a lower arm or hand When using a triangular bandage it is important injury and for rib or collarbone fractures. Child Resuscitation to use a reef knot to secure it in place. A reef knot is a flat knot that will not slip undone and, • Encourage the victim to Baby Resuscitation if correctly placed on the body, it is comfortable hold the affected arm across for the victim. the body in the position of Special Resuscitation greatest comfort. 1 Wrap the left end of the bandage over and CPR Chart then under the right end to start the knot. • First hold the bandage with the base running Abdominal Injuries down the centre of the body and the point Asthma to the elbow on the Allergic Reaction affected side. Gently slip the top Bites and Stings point under the supported arm and Bleeding wrap it around the Burns and Scalds 2 Wrap the right end over and then under the back of the neck until left end to complete the knot. it rests on the shoulder of the affected side. Chest Injuries 3 Pull the knot tightly from both sides to ensure • Lift up the lower point and Childbirth/Miscarriage that it will lie flat. take it to meet the upper point at the side of the neck on the Choking affected side. Cold Illness • Use a reef knot to tie the ends together just above the Convulsions/Seizures collarbone to avoid any pressure on the back Croup of the neck. • Adjust the sling so that Diabetes the finger tips are Untying a reef knot clearly visible Drug/Alcohol Overdose and then bring It is easy to untie a reef knot without jarring or Eye Injuries hurting the victim. Simply choose two paired the point forward and ends as they come out of the knot at one side. Fractures/Dislocations Then pull the ends apart steadily until two loops fasten it to the form and can be slipped off one end. sling with a safety pin. Head Injuries • Finally, check the circulation in the fingers Heart Conditions and compare the tissue colour with the finger Heat Illness tips on the unaffected arm. Hyperventilation If there are any signs of an impaired circulation, Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED loosen or remove the sling and any underlying Poisoning bandages. Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 106 SKILLS AND PROCEDURES Adult Resuscitation Elevation sling Collar-and-cuff sling This sling is used for an arm or finger injury This sling is used to hold the lower arm and Adult Defibrillation where the victim needs the hand and arm to hand in an elevated position where a full be held in an elevated position. elevation sling is either not required, or for Child Resuscitation victim comfort in very hot weather. The sling is made with a narrow-fold bandage used as Baby Resuscitation • Encourage the victim to a clove hitch. hold the affected arm Special Resuscitation across the body with the fingers pointing to the • Make a clove hitch with two large loops of CPR Chart opposite shoulder tip. the bandage. One loop is made with the • First hold the bandage bandage end pointing upwards and the other Abdominal Injuries with the base running end pointing downwards. down the centre of • Fold the two loops inwards towards the Asthma the body and the point middle, ensuring that both ends are trapped to the elbow on the between the loops. Allergic Reaction affected side. Gently place the bandage over Bites and Stings the supported arm Bleeding and carry the top end around the front of the Burns and Scalds neck until it rests on the unaffected shoulder. Chest Injuries • Gently wrap the lower half of the bandage Childbirth/Miscarriage along the affected arm. Carry the free end Choking of the bandage from • Encourage the victim to hold the affected arm the elbow across the across the body with the fingers pointing to Cold Illness back to the opposite the opposite shoulder tip. Then gently slide shoulder tip. the two loops over the hand and lower arm Convulsions/Seizures with the ends hanging downwards. • Gently twist the top Croup point around the • Carry the two bandage ends up on either fingers, but avoid side of the limb and around the victim’s neck. Diabetes placing pressure on any Adjust the bandage so that it is possible to tie injury. Tie the two ends a reef knot just above the collarbone on one Drug/Alcohol Overdose together with a reef side to avoid any pressure on the neck. The knot and place it just knot may be placed on either side of the neck Eye Injuries above the collarbone depending on the location of the injury and to avoid any neck the comfort of the victim. Fractures/Dislocations pressure. • Finally, gently check the • At the point of the circulation in the fingers. Head Injuries elbow smooth the Compare the tissue loose fabric forwards colour with the finger tips Heart Conditions along the arm under on the unaffected arm. the sling. Secure the If there are any signs of Heat Illness sling firmly at the elbow an impaired circulation, with a safety pin. loosen or remove the Hyperventilation • Finally, gently open sling and any underlying bandages. Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED the top of the sling to

check the circulation in Poisoning the fingers. Compare the tissue colour with Shock/Fainting the finger tips on the unaffected arm. If Spinal Injuries there are any signs of an impaired circulation Sprains/Strains/Bruises loosen or remove the sling and any Stroke underlying bandages. Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 107 SKILLS AND PROCEDURES Adult Resuscitation Systems of the human body Adult Defibrillation Child Resuscitation Baby Resuscitation The respiratory system The heart and circulation Special Resuscitation Air enters the body through the mouth Blood flows continually around the body and nose where it passes over mucous in a vast network of blood vessels. The heart CPR Chart membranes and is moistened. Air then is the pump that drives blood through the flows down the trachea (windpipe) and arteries, which carry blood rich with oxygen Abdominal Injuries enters the lungs through a tree-like to all organs and tissues. The oxygen is structure of airway tubes. At the end of exchanged for carbon dioxide in a network Asthma each small tube (bronchiole) is a cluster of capillaries before the oxygen depleted of air sacs called alveoli. blood returns to the heart and lungs Allergic Reaction The lowering of the diaphragm and through the veins. relaxation of the muscles of the chest Arteries have thick muscular walls to Bites and Stings wall causes air to be drawn into the maintain the blood pressure within the lungs. When the diaphragm moves circulation, but veins have thinner walls Bleeding upwards and the chest muscles tighten, and a series of internal valves to assist the Burns and Scalds the total capacity of the lungs is reduced flow of blood back to the heart and lungs. and air moves out of the lungs into the A smaller circulation system exists between Chest Injuries atmosphere. the heart and lungs where carbon dioxide Blood is pumped from the heart to the is removed in the alveoli and oxygen added Childbirth/Miscarriage alveoli where oxygen is exchanged for to the blood in readiness for the next carbon dioxide and other waste gases, circuit around the body. Choking which are then exhaled. Cold Illness Average pulse rates Average breathing rates Adults Convulsions/Seizures Adults 10–20 breaths per minute 60 – 90 beats Children 20–28 breaths per minute per minute Croup Babies 28–40 breaths per minute Children 100–120 beats Diabetes per minute Drug/Alcohol Overdose Babies Windpipe 120–140 beats Eye Injuries (trachea) per minute Fractures/Dislocations Head Injuries

Lungs Heart Conditions Heat Illness

Red vessels Hyperventilation are the arteries Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED

Air passages Air sacs (bronchi) Blue vessels Poisoning (alveoli) are the veins Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 108 SKILLS AND PROCEDURES Adult Resuscitation

The skeleton The lymphatic system Adult Defibrillation

The skeleton forms the bony framework The lymphatic system consists of a vast Child Resuscitation of the body through a collection of around network of fine vessels that transport Baby Resuscitation 200 bones. Movement occurs through lymph throughout the body. The tonsils muscles, tendons and ligaments, which and spleen are two of the lymphatic Special Resuscitation give the body flexibility at joints. These organs. Lymphocytes are blood cells joints include: that are made as part of the body’s CPR Chart • fixed joints where bones are fused defence system. When infection occurs, together, e.g the skull additional lymphocytes are made to help Abdominal Injuries fight the infection and lymph nodes Asthma • ball and socket joints for a large range of (often called glands) become swollen in movement, e.g the shoulder and hip the neck, armpit or groin. Allergic Reaction • hinge joints for limited movement in one When toxins enter the body, e.g. from plane, e.g the elbow and knee snake or spider bite, the lymphatic Bites and Stings system carries the foreign material from • slightly moveable joints for some Bleeding flexibility, e.g the spinal vertebrae and ribs the entry site for destruction in the liver. Burns and Scalds Chest Injuries

Lymph nodes Childbirth/Miscarriage Cranium Jaw Choking Collarbone Cold Illness (clavicle) Shoulder blade Convulsions/Seizures (scapula) Croup Breastbone (sternum) Diabetes Rib Forearm bones Drug/Alcohol Overdose Radius Eye Injuries Ulna Fractures/Dislocations Pelvis Wrist bones Head Injuries Lymph vessels Thigh bone Heart Conditions (femur) Kneecap Heat Illness (patella) Lower leg bones Hyperventilation Shin (tibia) Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Fibula Poisoning Ankle bones Shock/Fainting Spinal Injuries Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX FIRST AID EMERGENCY eHANDBOOK 5th ed 109 SKILLS AND PROCEDURES Adult Resuscitation The digestive system The urinary system Adult Defibrillation The digestive system is a The urinary system is collection of organs and responsible for the Child Resuscitation tissues that process the food maintenance of fluid that we eat. Food enters balance by removing Baby Resuscitation the mouth, is chewed until Oesophagus surplus fluid and waste safe to swallow, and then Stomach from the body to Special Resuscitation moves down the gullet enable them to be (oesophagus) into the excreted through CPR Chart stomach for the first the bladder as urine. stage of digestion. Blood circulates Abdominal Injuries After mixing with through two kidneys various enzymes and which act as a Asthma stomach acid to break filtration system and surplus fluid down the food, it then Allergic Reaction moves down through and waste pass down to the the small and large Bites and Stings intestines where bladder through fluid and nutrients the ureters. are absorbed into Bleeding the circulation. The remaining Burns and Scalds waste material is collected in Chest Injuries the rectum Gall bladder and leaves the Pancreas Childbirth/Miscarriage body through Intestines Kidneys the anus as Rectum Choking faeces. Bladder Anus Cold Illness Convulsions/Seizures The nervous system The skin Croup The brain and spinal The skin is the largest organ in the body. Diabetes cord are the main It provides shape and a covering for the parts of the central bony and soft tissues of the body. The skin Drug/Alcohol Overdose nervous system. protects the body from infection and helps The brain processes with temperature control by sweating in hot information and Eye Injuries has many separate conditions and shivering when it is cold. functions including Fractures/Dislocations the automatic control of breathing, Head Injuries heartbeat and body temperature. Outer layer Heart Conditions The spinal cord (epidermis) consists of nervous Heat Illness tissue, which carries messages to and Hyperventilation from the brain. Sensory nerves carry Spinal cord Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED information about

heat, cold, pain etc. Poisoning to enable the Oil glands brain to coordinate Inner layer (dermis) a response. Motor Shock/Fainting nerves carry Sweat glands information about Spinal Injuries movement and the coordination of Sprains/Strains/Bruises physical activities. Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 110 GLOSSARY OF TERMS 1 of 3 Adult Resuscitation Bronchi: large air passages that divide from the Glossary of terms windpipe into the left and right lungs Adult Defibrillation Bronchioles: small air passages that divide from the Abdomen: the area below the chest, extending to and bronchi and lead to the alveoli Child Resuscitation including the pelvis, which contains the organs of digestion Bruise: a closed wound caused by a blow from a Baby Resuscitation Abrasion: a wound caused by scraping or rubbing blunt object Absorb: to take in fluids or gases through the tissues Special Resuscitation Adrenaline: a drug used in the emergency Capillaries: the smallest of blood vessels through CPR Chart management of various life-threatening conditions, which oxygen and nutrients pass to the cells including a severe allergic reaction. Carbon dioxide: in the air breathed out during Abdominal Injuries Adrenaline in an auto-injector device is available in respiration Australia in two strengths under the trade names of Carotid pulse: the pulse that can be felt over a Asthma EpiPen® and Anapen. carotid artery in the neck Airway: the passageway for air from the mouth and Allergic Reaction Cartilage: part of the supporting tissues found in nose to the lungs joints and between the vertebrae Bites and Stings Allergic: having an adverse reaction to a substance Cardio-pulmonary resuscitation (CPR): the (e.g. bee/wasp sting) that does not normally cause an combination of rescue breathing and heart Bleeding adverse reaction compression for the victim of cardiac arrest Burns and Scalds Alveoli: air sacs in the lungs where gas exchange Cervical: relating to the first seven vertebrae of the takes place spine Chest Injuries Amputation: the removal of a body part, e.g. finger, Chain of Survival: a four-stage international toe, arm, leg approach to the emergency care of the victim of Childbirth/Miscarriage Anaerobic: an organism such as tetanus that thrives cardiac arrest that gives the best possible chance without oxygen of survival Choking Anapen: see Adrenaline Circulation: the flow of blood around the body Cold Illness Anaphylactic shock: a severe allergic reaction to a Cold pack: a cold dressing that assists control of foreign protein entering the body bruising and swelling and helps relieve pain Convulsions/Seizures Angina (angina pectoris): a heart condition caused Communicable disease: a disease that may be by poor blood supply to the heart muscle resulting in transferred from one person or animal to another Croup chest pain which increases with activity or stress Concussion: loss of balance, loss of memory, poor Diabetes Antiseptic: a chemical used to clean wounds and response, nausea and blurred vision associated with reduce the risk of infection head injuries Drug/Alcohol Overdose Anus: the outside opening of the bowel Convulsion: a seizure of childhood usually associated with a high temperature Eye Injuries Artery: a blood vessel taking blood to the body from the heart CPR (Cardio-pulmonary resuscitation): the combination of rescue breathing and heart Fractures/Dislocations Aseptic Technique: protection against infection by compression for the victim of cardiac arrest using a sterile approach to wound care Head Injuries Cranium: the portion of the skull containing the Assessment: to identify a victim’s condition (injuries or brain, excluding the face and jaw illness) by observation, examination and questioning Heart Conditions Crater wound: a large open wound where skin, Asthma: a condition that constricts the airway, causes fatty tissue and muscle have been torn away Heat Illness congestion and reduces air flow in and out of the lungs Hyperventilation Defibrillation: the use of an automated external Bladder: an organ acting as a reservoir, e.g. urinary defibrillator to restore normal heart rhythm. Mouth/Tooth Injuries

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED bladder (for urine), gall bladder (for bile) Dehydration: the loss of fluid or moisture Blood pressure: the force exerted by the blood Poisoning against the walls of blood vessels; the force required to Diabetes: disease caused by the inadequate circulate the blood around the body production of insulin in the pancreas Shock/Fainting Diaphragm: a large muscle, used in breathing, Bowel: that part of the digestive system which Spinal Injuries collects, stores and expels waste from the body dividing the chest from the abdomen Brachial pulse: the pulse that can be felt in a baby on Dislocation: where a joint has been pulled apart Sprains/Strains/Bruises the upper arm, between the biceps and triceps muscle Disorientation: confused in direction, and having Breastbone (sternum): the bone extending down the an inability to function normally Stroke centre of the chest and connected to the rib cage Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 111 GLOSSARY OF TERMS 2 of 3 Adult Resuscitation Epilepsy: a group of neurological disorders in which Ligament: tissues that connect bone to bone at a joint there is an electrical disturbance in the brain, often Liver: an organ in the upper right hand side of the Adult Defibrillation causing a seizure abdomen which assists in digestion, and maintains EpiPen®: see Adrenaline normal blood sugar levels Child Resuscitation Exhale: the process of breathing out Lungs: two organs in the chest where oxygen Baby Resuscitation Extremities: the fingers, toes, nose or ear lobes is absorbed into the blood and carbon dioxide is removed from the blood Special Resuscitation Faeces: waste discharged from the bowel Mucous membrane: the tissue that lines the CPR Chart Fainting: momentary loss of consciousness caused by respiratory and alimentary tracts insufficient blood supply to the brain Abdominal Injuries Mucus: a slippery and sticky secretion from mucous Flammable: easily set on fire membranes that lubricates and protects some parts Asthma Fracture: a break in a bone of the body Muscles: tissues which perform movement by Allergic Reaction contracting and relaxing Gall bladder: an organ in the upper abdomen that Bites and Stings stores bile Genitals: the external organs of reproduction Nausea: a feeling of the need to vomit Bleeding Gland: any organ or group of cells that secrete specific Nerves: bundles of fibres interconnecting the nervous Burns and Scalds substances system with the organs and other parts of the body Chest Injuries Heat stroke: a condition caused by overheating of the Oesophagus: the canal that extends from the Childbirth/Miscarriage body to a level that endangers life pharynx to the stomach and carries food and fluids History: information of the incident gathered to for digestion Choking identify how the injury or illness occurred Organ: different tissues grouped together in the Hyperglycaemia: higher than normal levels of sugar body to perform specific functions Cold Illness in the blood Oxygen: a colourless, odourless, tasteless gas Convulsions/Seizures Hyperthermia: higher than normal body temperature essential to life, comprising approximately 21% of the air inhaled into the lungs during respiration Hypoglycaemia: lower than normal levels of sugar Croup in the blood Hypothermia: lower than normal body temperature Pancreas: a gland in the upper portion of the abdomen Diabetes that produces insulin and other digestive juices Drug/Alcohol Overdose Immobilise: to stop movement Pelvis: the bones that support and protect the pelvic organs Eye Injuries Incision: a wound caused by a sharp edge Pharynx: the muscular tube at the back of the Infection: illness caused by the invasion into the body mouth and nose which joins the oesophagus Fractures/Dislocations of pathogenic micro-organisms Pressure Immobilisation Bandaging technique Head Injuries Inflammation: swelling and redness of tissues as they (PIB): the application of a pressure bandage to delay react to infection, irritation or injury entry of venom into the general circulation Heart Conditions Inhale: the process of breathing in Pulmonary: referring to the lungs Insulin: a hormone released by the pancreas to assist Heat Illness Pulse: expansion and contraction of an artery felt cells to utilise sugar through the skin as the heart pumps blood Hyperventilation Intestine: portion of the digestive system extending Pupil: the small black opening in the centre of the from the stomach to the anus coloured part of the eye Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Irrigate: to flush with a continual flow of fluid Poisoning Recovery Position: the safe and stable position for Jaw support/jaw thrust: methods used to open a a breathing but unconscious victim Shock/Fainting victim’s airway Red blood cells: part of the blood that carries oxygen Spinal Injuries to the tissues and returns carbon dioxide to the lungs Larynx: the structure at the top of the trachea that Regurgitation: the silent and passive emptying of Sprains/Strains/Bruises contains the vocal cords the stomach in an unconscious victim with serious Laryngectomy: the surgical removal of all or part of risks to the airway unless the victim is on the side Stroke the larynx Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 112 GLOSSARY OF TERMS 3 of 3 Adult Resuscitation Rescue breathing: a treatment for a non-breathing Tetanus: a life-threatening infection which affects person to provide air by breathing into the victim the nervous system following contamination of a Adult Defibrillation wound with soil or dust particles carrying tetanus Respiration: movement of air in and out of the lungs spores Child Resuscitation in breathing Tissues: a group of cells that perform a special Baby Resuscitation Response: required to identify if a victim is conscious function, e.g. the lining of the mouth Resuscitation: any effort to artificially restore or Torso: that part of the body containing the chest, Special Resuscitation provide normal heart and/or lung function abdomen and pelvis Toxic: to be poisonous CPR Chart Seizure (convulsion, fit): uncontrolled and Trachea: the tube extending from the voice box to Abdominal Injuries unconscious muscle spasms its division into the main bronchi, also known as the Shock: a failure of the body to maintain an adequate windpipe Asthma blood supply to all the organs and tissues following Trauma: a physical or psychological injury illness or injury Allergic Reaction Triage: the process of assessing multiple victims to Side-effect: the unintended effects of taking a determine the priorities of care medication, drug or poison Bites and Stings Signs: the obvious indications of a victim’s injuries or Bleeding illness, e.g. skin colour, bruising, swelling, bleeding Unconsciousness: a condition in which the victim fails to respond to the spoken word or a touch Skeleton: the bony structure of the body that protects Burns and Scalds and supports the soft organs and tissues Urine: a waste fluid filtered from the blood by the kidneys Chest Injuries Skull: the bones of the head that surround and protect the brain Childbirth/Miscarriage Spasm: abnormal, sudden and continuous muscle Vein: a vessel that carries blood toward the heart contraction Venom: a poisonous fluid, which is produced by Choking certain animals (e.g. snakes, spiders) Spinal cord: the nervous tissue contained within the Cold Illness spinal bones (vertebrae) which carries messages to and Vertebrae: the bones that comprise the spinal from the brain column Convulsions/Seizures Spleen: the organ in the left upper abdomen that Vomiting: the forceful ejection of stomach contents stores blood and destroys old blood cells through the mouth in a conscious person Croup Sprain: an injury caused by over-stretching of the Vomitus: the substance expelled from the stomach Diabetes ligaments at a joint by vomiting Sputum: mucus which is expelled from the mouth Drug/Alcohol Overdose Sterile: containing no living micro-organisms White blood cells: blood cells which fight off Eye Injuries Sternum (breastbone): the bone extending down infection the centre of the chest and connected to the ribcage Windpipe: the air passage between the larynx Fractures/Dislocations Stoma: an artificial opening on the body surface (voice box) and the main bronchi in the lungs e.g. laryngeal stoma after surgery to remove the larynx Wound: an injury that involves a break in the skin Head Injuries Stomach: the organ in the abdomen that receives and Heart Conditions breaks down food material Strain: injury caused by over-stretching of a muscle or Heat Illness tendon Hyperventilation Stroke: the sudden cessation of circulation to an area of the brain, caused by a clot or bleeding ACKNOWLEDGEMENTS Mouth/Tooth Injuries UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Suffocation: to die from lack of air The publisher gratefully acknowledges the support Symptom: what the victim feels from their injury or of the following who provided photographs for this Poisoning illness edition: Shock/Fainting • Pratt Safety Systems, for the illustration of a safety shower Tendon: a fibrous band of tissue that attaches muscle Spinal Injuries to bone • Dr Michael Gray, for the Funnel Web and Red Back spider illustrations Sprains/Strains/Bruises Stroke Skills and Procedures

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© 201 © INDEX 1 FIRST AID EMERGENCY eHANDBOOK 5th ed 113 1 of 3 Adult Resuscitation Index Click on the page number to take you to the relevant information. Adult Defibrillation A Child Resuscitation ABC of resuscitation, 5 Basic Life Support Flow Chart, 4 Concussion, 62, 69-70, 99 Baby Resuscitation Abdomen Bee and wasp stings, 31 Cone shell sting, 34 ..distension of, 16, 21 Bites and stings, 29-34 Confined space, first aid ,in 78, 97 Special Resuscitation ..injury to, 25, 40, 99 Blanket lift, 96 Congestive heart failure, 71 CPR Chart ..organs of, 25 Blast injury, 37 Conscious state, 69-70, 90 Abrasion(graze),39, 101 Bleeding, 35-40 Consent, 87 Abdominal Injuries Absorbed poisons, 78 ..external, 35-39 Convulsions, 55-56 Asthma Accidental overdose of drugs, 60 ..internal, 40 Coronary thrombosis – see Heart AED, 9, 10-11, 16, 72 Blue-ringed octopus bite, 34 attack Allergic Reaction Afterbirth, 48 Body fluids, avoiding contact, 35, 39 CPR (Cardiopulmonary Resuscitation), 4, 5, 10, 12, 17, 22, 24 Bites and Stings Airway Box Jellyfish sting, 33 Croup, 57 ..management, 4, 5, 12, 17, 22, BPC dressing, 101 Bleeding Crush injury, 38 56, 60, 90, 97 Bruise, 83 Cultural awareness, 87 Burns and Scalds ..obstruction, 31, 51, 57, 59, 97 Bullrout sting, 34 ..spasm, 26 Burns and scalds, 41-44 D Chest Injuries Alcohol overdose, 59-60 ..bitumen, 43 Debriefing, 99 Childbirth/Miscarriage Allergic reaction, 27-28, 31-32, 75 ..chemical, 43 Defibrillation, 5, 10, 16, 72 Amputation, 37 ..electrical and lightning, 43 Delivery of baby, 47 Choking Anapen, 27-28 ..full thickness, 41 Dentures, removal of, 6 Cold Illness Anaphylactic shock, 27-28, 51 ..inhalation, 44 Diabetes, 58, 89 Angina, 71 ..partial thickness, 41 Direct pressure on wound, 35, 37, 63 Convulsions/Seizures Antivenom, availability, 29-30, 33 Dislocation C Croup Arm Drag Method, 95 ..ankle, foot, toes, 68 Artery, 35, 107 Capillary, 35 ..collarbone, 65 Diabetes Assessment of a sick or injured Cardiac arrest, 10 ..elbow, 66 person, 81, 89 Cardiopulmonary resuscitation Drug/Alcohol Overdose ..finger, 67 Asthma, 26 – see CPR ..knee joint, 68 Eye Injuries ..preventer inhaler, 26 Cat or dog bite, 32 ..shoulder, 65 ..reliever inhaler, 26 Chain of Survival 24 Fractures/Dislocations ..see also Fractures ..spacer, 26 Chemical, Dog or cat bite, 32 Head Injuries Australian Venom Research Unit ..burns, 43, 94 Dressings, 101 (AVRU), 33, 34 ..spills, 3, 94 Heart Conditions Chest injuries, 45-46 ..adhesive strip, 101 Avulsion, 39 Heat Illness Chest thrusts, 52 ..combine, 101 B Child resuscitation, 12 ..improvised, 65-66, 82, 101 Hyperventilation Baby resuscitation, 17 Childbirth, 47-50 ..non-adherent, 39, 41-42, 101 Back blows, 51-52 Mouth/Tooth Injuries ..complications, 49 ..sterile wound, 61, 100 Bandages, 101-106 ..see also Bandages

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Poisoning ..miscarriage, 50 ..broad-fold, 104 Choking, 51-52 Drugs and alcohol, 59-60 ..narrow-fold, 104 Shock/Fainting Clothing Drag, 95 ..accidental overdose, 60 ..roller bandage, 103 Clothing on fire, 44, 94 ..recreational, 59 Spinal Injuries ..sling, 104 Cold compress, 31, 34 Duty of care, 87-88 ..triangular, 104 Sprains/Strains/Bruises ..tubular, 101 Cold illness, 53-54, 92 Stroke ..see also Dressings Compression of the brain, 69 Skills and Procedures

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© 201 © INDEX 2 FIRST AID EMERGENCY eHANDBOOK 5th ed 114 INDEX 2 of 3 Adult Resuscitation Adult Defibrillation E Fumes, toxic, 91, 94 M Electricity, danger, 91 Funnel Web spider bite, 29 Marine bites and stings, 33 Child Resuscitation Emergency Material Safety Data Sheet (MSDS) 43, 94 G Baby Resuscitation ..assessment, 89 Medic Alert pendant, 56 Glossary of terms, 110 ..procedures, 95 Miscarriage, 50 Gloves,inCPR,8 Special Resuscitation Epiglottitis, 57 Motor vehicle accident, 92 Gloves, disposable, 35, 100 Epileptic seizure, 55 Motorcycle accident, 93 CPR Chart Greenstick fracture, 63 Epipen, 27-28 ..removal of helmet, 93 Abdominal Injuries European wasp, 31 H Mouth and tooth injuries, 75-76 External bleeding, 35 Handover, to emergency services, 90 Mouth to mask rescue breathing, 8 Asthma Eye injuries, 61-62, 64, 99 Hazchem sign, 94 Mouth-to-mouth-and-nose Allergic Reaction Head injuries, 69-70 rescue breathing, 15, 20 F Heart attack, 71-72 Mouth-to-mouth rescue breathing Bites and Stings Face mask, use in EAR, 8 Heart conditions, 71 – see Rescue breathing Fainting, 79-80 Bleeding Heat illness, 73 Moving a sick or injured victim, 95 Fever, 31, 55-56, 57, 90 ..exhaustion, 73 Multiple victims, assessment, 99 Burns and Scalds Fire ..stroke, 73, 79 ..danger in, 94 Myocardial infarct (MI), 71 Chest Injuries Helmet removal, 93 ..clothing on fire, 44 N High-velocity wound, 39 Childbirth/Miscarriage ..Stop, Drop and Roll method, 94 Needle stick injury, 60 High-voltage electricity, 91 First aid Negligence, 87 Choking History, taking victim, 89 ..basic rules, 100 Hydrofluoric acid burns, 43, 94 Nematocysts, 33 Cold Illness ..emergency procedures, 95 Hyperglycaemia, 58 Nose, bleeding, 38 ..infection control, 100 Convulsions/Seizures Hyperthermia, 73 O ..legal implications, 87 Hyperventilation, 74 Observation Chart, 90 Croup ..kits, 88 Hypoglycaemia, 58 Occupational First Aider, 88 ..principles, 87 Diabetes Hypothermia, 42, 53, 92 Occupational Health Nurse, 88 ..safety, 91 Hysterical over-breathing, 74 Occupational Health, Safety and Drug/Alcohol Overdose ..workplace, 88 Welfare Act, 88 Flail chest, 45, 65 I Eye Injuries Overdose – see Drugs and alcohol Flash injury, 61 Ice pack, 31, 34, 73, 84 Fractures/Dislocations Fluid, balance and output, 98, 109 Incised wound, 39 P Fractures and dislocations, 63-68 Infection control in first aid, 100 Paraplegic – see Spinal injuries Head Injuries ..ankle, foot or toes, 68 Ingested (swallowed) poisons, 78 Partial airway obstruction, 51 Heart Conditions ..collarbone, 65 Inhalation burns, 44 Petitmal (seizure), 55 ..elbow, 66 Inhaled poisons, 78 Phosphorus burns, 43 Heat Illness ..face or jaw, 64 Injected poisons, 78 Placenta, delivery of, 48 Hyperventilation ..finger, 67 Internal bleeding, 40, 46, 61, 84, 85 Poisoning, 77-78 ..hand, 67 Irukandji jellyfish sting, 33 Poisons Mouth/Tooth Injuries ..absorbed, 78 ..hip, 67 L

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Poisoning ..inhaled, 78 ..knee joint, 68 Laceration, 39 ..injected, 78 ..lower arm or wrist, 66 Laryngectomy stoma, 22 Shock/Fainting ..ingested (swallowed), 78 ..lower leg, 67 Leg Drag, 95 Poisons Information Centre, 3, 77-78 Spinal Injuries ..ribs, 65 Legal implications of first aid, 87 Post-traumatic stress, 99 ..upper arm, 66 Lightning burn, 43 Sprains/Strains/Bruises Frostbite, 53-54 Pulse rates, average, 107 Log-roll technique, 96 Stroke Lymphatic system, 30, 108 Skills and Procedures

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© 201 © INDEX 3 FIRST AID EMERGENCY eHANDBOOK 5th ed 115 INDEX 3 of 3 Adult Resuscitation Pregnancy, resuscitation during, 23 Shoulder joint, dislocation, 65 Adult Defibrillation Pressure Immobilisation Bandaging Slings V Child Resuscitation Technique, 29 ..arm, 105 Vein, 23, 35, 49, 107 Preventer inhaler, 26 ..collar-and-cuff, 106 Venomous snake bite, 30 Baby Resuscitation Pulse checks, 90 ..elevation, 106 Vital signs, recording, 98 Pulse rates, average, 107 Special Resuscitation Soft tissue injuries, 83 W Q Snakes, venomous, 30 Water, CPR Chart Quadriplegic – see Spinal injuries Spacer inhaler, 26 ..accidents in, 92 Abdominal Injuries Spider bites, 31 R ..resuscitation in, 22 Spinal injuries, 81-82 Radio link, 97 White-tail spider bite, 31 Asthma ..in water, 82 Recording vital signs, 98 Workplace first aid, 88 Allergic Reaction Sprain, 83-84 Recovery Position Wound dressings, sterile, 101 Sterile gauze squares,101 ..adult,5 Wounds Bites and Stings Sterile non-adherent dressings, 101 ..baby,17 ..abrasion, 39 Bleeding Sternum, location of 7, 14, 18, 52, 108 ..child, 12 ..amputation, 37 Stingray sting, 34 Burns and Scalds Red Back spider bite, 31 ..avulsed, 39 Stonefish sting, 34 Reef knot, 105 ..blast injury, 37 Chest Injuries Stop, Drop and Roll method, 44, 94 Regurgitation, 16, 21, 23 ..closed, 35 Strain, 83-84 Childbirth/Miscarriage Reliever inhaler, 26 ..crush injury, 38 Stress,afteranemergency,99 Remote area, care of victim in, 29, ..high-velocity wound, 39 Choking Stroke, 85-86 30, 63, 76, 96, 97 ..laceration, 39 Systems of the human body,107-109 Cold Illness Rescue Breathing, 8, 15, 20, 22, ..puncture, 39 ..digestive system, 109 92, 93, 97 ..rules for care, 100 Convulsions/Seizures ..heart and circulation, 107 Respect, 87 ..special care of, 37 Resuscitation ..lymphatic system, 108 Croup ..adult, 5 ..nervous system, 109 Diabetes ..baby, 17 ..respiratory system, 107 ..child, 12 ..skeleton, 108 Drug/Alcohol Overdose ..laryngectomy stoma, 22 ..skin, 109 Eye Injuries ..in pregnancy, 23 ..urinary system, 109 ..in water, 22 Fractures/Dislocations Resuscitation Summary Chart, 24 T Head Injuries Road accidents, 92-93 Tetanus, 32, 39 .. multiple victims, 99 Tick bite, 32 Heart Conditions Roller bandages, 102 Tooth, knocked out, 76 Heat Illness ..applying, 102 Total airway obstruction, 51-52 ..elbow or knee, 103 Toxic fumes, 94 Hyperventilation ..hand or foot, 104 Transient ischaemic attack (TIA), 85 Mouth/Tooth Injuries ..lower arm or leg, 103 Trapped victims, 97

UNAUTHORISED REPRODUCTION AND DISTRIBUTION IS PROHIBITED Royal Flying Doctor Service Poisoning Triage, 99 (RFDS), 29, 97 Triangular bandage, applying, 104 Shock/Fainting S Tulle gras dressing, 101 Spinal Injuries Safety and first aid, 91 Scalds – see Burns and Scalds U Sprains/Strains/Bruises Seizures,55-56 Umbilical cord, tying, 48 Stroke Shelter for victim, 98 Shock, 79-80 Skills and Procedures

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© 201 © INDEX